PRE-TASK PLAN

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Project

• Number

• Leader

• Date started

• Date completed

SAFETY GOALS

• Zero injuries / incidents

• Balance productivity & safety

CREW MEMBERS

• Tap to enter information

GENERAL CHECKLIST

• MSDS reviewed for tank?

  Yes

  No

  N/A

• Proper safety equipment on jobsite?

  Yes

  No

  N/A

• Guards and handles on power tools?

  Yes

  No

  N/A

• Confined space procedures / rescue plan?

  Yes

  No

  N/A

• Power lines located above / below ground?

  Yes

  No

  N/A

• Rigging and harness inspected?

  Yes

  No

  N/A

• Emergency procedures and contacts?

  Yes

  No

  N/A

• Work communicated with others in areas?

  Yes

  No

  N/A

Personal Protective Equipment

• Safety glasses / side shields

  Yes

  No

  N/A

• Goggles

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Other clothing, skin protection

  Yes

  No

  N/A

• Face shield

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Respirator / dusk mask

  Yes

  No

  N/A

• Hard hat

  Yes

  No

  N/A

• Fall protection

  Yes

  No

  N/A

LOCK OUT/TAG OUT CHECKLIST

• Is a lockout required?

  Yes

  No

  N/A

• Has the system been walked?

  Yes

  No

  N/A

• Has owner isolated system and placed lock?

  Yes

  No

  N/A

• Is your lock in place?

  Yes

  No

  N/A

• Has the system been test started?

  Yes

  No

  N/A

POSSIBLE HAZARDS

• Chemical burn

  Yes

  No

  N/A

• Thermal burn

  Yes

  No

  N/A

• Particles in eyes

  Yes

  No

  N/A

• Overexertion

  Yes

  No

  N/A

• Dropping materials

  Yes

  No

  N/A

• Inhalation of hazards substances

  Yes

  No

  N/A

• Vehicle collisions

  Yes

  No

  N/A

• Cuts

  Yes

  No

  N/A

• Fire

  Yes

  No

  N/A

• Spill

  Yes

  No

  N/A

• Abrasions

  Yes

  No

  N/A

• Cave-in

  Yes

  No

  N/A

• Loud noises

  Yes

  No

  N/A

• Heat stress

  Yes

  No

  N/A

LIST HAZARDS ASSOCIATED WITH EACH TASK

• Tap to enter information

WAYS TO ELIMINATE HAZARDS

• Rubber gloves

  Yes

  No

  N/A

• Chemical gear

  Yes

  No

  N/A

• Fall protection plan

  Yes

  No

  N/A

• Electrical hot work gear

  Yes

  No

  N/A

• Appropriate gloves

  Yes

  No

  N/A

• Eye/face protection

  Yes

  No

  N/A

• Enough people to complete the task

  Yes

  No

  N/A

• Clean approved respirator

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Housekeeping

  Yes

  No

  N/A

• Proper tool for the job

  Yes

  No

  N/A

• Electrical cords off the floor

  Yes

  No

  N/A

• Barricades with signs in place

  Yes

  No

  N/A

• Sparks contained, combustibles removed

  Yes

  No

  N/A

• Make fire extinguishers available

  Yes

  No

  N/A

• Get additional training for task

  Yes

  No

  N/A

• Correct body position for task

  Yes

  No

  N/A

• Competent person for shoring or safe slop

  Yes

  No

  N/A

• Stretch and flex

  Yes

  No

  N/A

• Competent person for scaffolding

  Yes

  No

  N/A

• Spill kit

  Yes

  No

  N/A

• Drive to work safety

  Yes

  No

  N/A

• DO YOU HAVE THE TOOLS AND MATERIALS TO COMPLETE THE TASK?

  Yes

  No

  N/A

WHAT TOOLS, MATERIALS OR EQUIPMENT DO YOU NEED?

• Tap to enter information