NorCal Safety: Pre-Task Planning

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Description of Work:

Location of Task:

Evaluating Your Work Area- Answer Yes or No

• Has the competent person performed required inspections?

  Yes

  No

  N/A

• Are you working around line systems?

  Yes

  No

  N/A

• Does this task require special training?

  Yes

  No

  N/A

• Is an MSDS review necessary for this task?

  Yes

  No

  N/A

• Is air monitoring required?

  Yes

  No

  N/A

• Are other work permits required for this task?

  Yes

  No

  N/A

• Are you familiar with the evacuation routes?

  Yes

  No

  N/A

• Has the emergency equipment such as fire extinguishers, eye wash stations, safety showers, and phones been located?

  Yes

  No

  N/A

• Has each employee been trained in how to perform this task safely and informed of the hazards associated with task?

  Yes

  No

  N/A

• If the work area is congested, has the work plan been coordinated with other crafts?

  Yes

  No

  N/A

• Do you have the required PPE needed for this task?

  Yes

  No

  N/A

• Are the required materials and tools provided?

  Yes

  No

  N/A

• Have all tools/equipment been inspected before use?

  Yes

  No

  N/A

• Does this task involve a confined space?

  Yes

  No

  N/A

• Should the Safety Dept. be involved in this planning?

  Yes

  No

  N/A

• Is there a safety issue that has not been addressed?

  Yes

  No

  N/A

Potential Hazard Checklist (place a mark in all that apply)

• Caught In-between

• Thermal Burns

• Particles in Eyes

• Elevated Work

• Poor Housekeeping

• Electrical Shock

• Chemical Burns

• Fire/Explosion

• Inadequate Access

• High Noise Levels

• Struck By

• Manual Lifting

• Chemical Spill

• Plant Operations

• Scaffolding

• Mobile Equipment

• Hazardous Chemicals

• Heat Exhaustion/Stress

• Sharp Objects or Tools

• Radiations

• Excavations-Trenches

• Lockout/Tagout

• Ladders

• Rigging

• Falls from Elevations

• Confined Spaces

• Line Breaking

• Inhalation Hazard

• Critical Lift

• Compressed Gases

• Slip Trip Hazards

Description of steps to be performed

• 1.

• 2.

• 3.

• 4.

Hazards Associated with Each Step

• 1.

• 2.

• 3.

• 4.

Required to Eliminate or Control the Hazard

• 1.

• 2.

• 3.

• 4.

Signatures

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