Title Page
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Line or Area
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Date of non-routine task/QRP conducted
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Describe the non routine task in a few words (title)
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Equipment involved for the non-routine task
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Name of all employees involved in completing the task and QRP
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Supervisor Signature
What Are You About To Do?
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Describe in detail the non-routine job task or activity?
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Is a standard operating procedure or safe practice available?
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Should a procedure be made for the task?
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Critique, document and share the job task in the form of an SOP or safe practice with employees for future use.
How Could I Get Hurt?
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What are the hazard(s)?
- Struck by
- Caught in
- Pinched
- Hot/Cold Surface
- High Pressure
- Chemical Exposure
- Spill
- Slip, Trip and Fall
- Electrical Shock
- Body Position
- Fire/ Explosion
- Un-expected Moving Parts
- Lack of Ventilation
- Other
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Preventative Measures: What am I going to do to prevent a serious injury?
What Do I Need To Do This Job Safely?
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Does the task need to be performed in a certain way or monitored?
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How will the task will be performed or monitored.
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Is the standard PPE required being used and is it enough to prevent injury during the non-routine task?
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Stop Work. Obtain and use the necessary PPE, review prevention measures.
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Should the non-routine task or activity be reviewed and documented in a written procedure?
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How will the critique of the job task be accomplished and who will be responsible for documentation?
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Should new findings of safe practices be shared with employees to improve awareness?
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Create a safe practice using the documented findings found while completing this QRP. Once a safe practice is documented, share/post near equipment associated with the task for employee future use.
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Any other measures not previously identified to ensure work is done safely?
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What additional measures need to be implemented prior to completing the task?
