Pre-Work Checklist (Yellow Card)

• Site

• Conducted on

  Date

• Prepared by

EVERY TASK CAN BE COMPLETED SAFELY AND WITHOUT ENVIRONMENTAL INCIDENT All accidents, injuries, fires, and near misses, no matter how small, shall be reported immediately

• Job Description

Work Area Assessment

• Do I know the wind direction?

  Yes

  No

  N/A

• Do I know where to find a safety shower, fire extinguisher, and fire monitor?

  Yes

  No

  N/A

• Is a safe means of access and exit provided to my work area?

  Yes

  No

  N/A

• Do I know how and have the means available to report an emergency?

  Yes

  No

  N/A

• Do I know what to do in the event of an emergency? (Understand alarm system, evacuation routes, assembly areas, etc.)

  Yes

  No

  N/A

• Have I identified potential safety and environmental hazards associated with this task and taken all reasonable steps to remove them?

  Yes

  No

  N/A

Behavior

• Am I in the right frame of mind and focused on the task at hand? (Motivated, ready to work safely, etc.)

  Yes

  No

  N/A

• Do I know how to do this task safely and without environmental incident?

  Yes

  No

  N/A

• Do I need a second opinion or help performing this task? (It's OK and expected that you get help when needed)

  Yes

  No

  N/A

Tools

• Do I have the correct tool(s) and equipment to perform the task safely and without environmental incident?

  Yes

  No

  N/A

• Have I inspected the tools and verified that they are safe to use?

  Yes

  No

  N/A

Secondary Effects

• Have I informed others in the area that might be affected by what I am doing?

  Yes

  No

  N/A

• Am I aware of "the line of fire"?

  Yes

  No

  N/A

• Is my work properly controlled so that my coworkers and I will not be adversely affected by potentially hazardous conditions resulting from this task?

  Yes

  No

  N/A

• Does the task at hand affect a downstream process and have those effects been communicated to those process owners?

  Yes

  No

  N/A

Reminder / Responsibility

• Am I aware of the written as well as the unwritten procedure associated with this task?

  Yes

  No

  N/A

• Have I identified potential sources of leaks or spills associated with task and made plans to address these possible sources? (Secondary containment)

  Yes

  No

  N/A

• Does this task require a safe work permit?

  Yes

  No

  N/A

• Did the process overview on the safe work permit adequately cover all pertinent information required to safely complete the task at hand?

  Yes

  No

  N/A

• Does this task require an MOC?

  Yes

  No

  N/A

• I will clean up when this task is complete. (Leave it better than I found it)

  Yes

  No

  N/A

• I will dispose of waste properly. (And, if I don't know, I will ask)

  Yes

  No

  N/A

• I know I can complete this task safely and without environmental incident. (If not, I will ask for help and repeat this checklist before starting work)

  Yes

  No

  N/A

Personal Protection

• Do I know the proper PPE for this task and am I wearing it? (Follow safe work practices and MSDS)

  Yes

  No

  N/A

• Do I need to familiarize myself with an MSDS for this job?

  Yes

  No

  N/A

• Suggestions for improved safety and environmental performance: