Celise Rico

Pre-Task Assessment

Must Be Filled Out For Every PM or W/O

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Title Page

Site conducted
Conducted on
Prepared by
Vendor
CBRE Work Order Number
MMC Number
Reviewed SOW details and supporting documents
All Instructions are fully understood

PPE REQUIRED

Proper Gloves
Hearing Protection
Face Shield
Goggles
Safety Glasses
Arc Flash Protection Needed
- Yes
- No
- N/A
Fall Protection Required

HAZZARDS IDENTIFIED

Heat Stress Apparent
Elevated Work/Overhead Work Apparent
Sharp Edges Apparent (Cuts)
Slips Trips and Falls Apparent
Inhalation of Hazzordous Chemicals Apparent
Electrified Equipment Apparent
Spills/Leaks Apparent
Burns (Thermal or Chemical) Aparent
Insects Apparent
Fire Life Safety Put on Test
Weather OK for Work
Hot Work Permit

GENERAL SAFETY

Eye Wash Available Near
Tool Inspection
Signs/Barricades/Signals in place if Needed
LOTO Completed if Needed
Aware of Fire Estinguisher Locations
GFCI Outlets Available
Ladder Tags Current
Confined Space Work
- Yes
- No
- N/A
Signature

Celise Rico

Pre-Task Assessment

Must Be Filled Out For Every PM or W/O

Use this Template

Print as PDF

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