TD Pre-task Safety Plan

• WO#

• Customer

• Date/time

  Date

• Technician

• Location
  Address

Job Information

• Trade

• Task(scope)

Break Task Into Steps

• Step 1

• Hazards Associated with Step 1

• Add media

  Media

• Safe Work Procedures / PPE for Step 1

• Step 2

• Hazards Associated with Step 2

• Add media

  Media

• Safe Work Procedures / PPE for Step 2

• Step 3

• Hazards Associated with Step 3

• Add media

  Media

• Safe Work Procedures / PPE for Step 3

• Step 4

• Hazards Associated with Step 4

• Add media

  Media

• Safe Work Procedures / PPE for Step 4

• Step 5

• Hazards Associated with Step 5

• Add media

  Media

• Safe Work Procedures / PPE for Step 5

• Step 6

• Hazards Associated with Step 6

• Add media

  Media

• Safe Work Procedures / PPE for Step 6

Jobsite and Task Checklist

• Are permits required? (hot work, confined spaces, etc.)

  Yes

  No

  N/A

• Is special training needed? (Forklift, Scaffold, Powder Actuated Tool)

  Yes

  No

  N/A

• Can weather conditions affect safety?

  Yes

  No

  N/A

• Is lighting a problem?

  Yes

  No

  N/A

• Contact with acids, toxic or caustics? (SDS)

  Yes

  No

  N/A

• Will there be exposure to dust, fumes or mist? (SDS)

  Yes

  No

  N/A

• Is the partner working with sharp or rough materials that require PPE?

  Yes

  No

  N/A

• Can the partner slip, trip or fall?

  Yes

  No

  N/A

• Do tools, machines or equipment present any hazards?

  Yes

  No

  N/A

• Can any body part get caught in, struck by or caught between objects? THIS INCLUDES HANDS, THINK BEFORE YOU REACH

  Yes

  No

  N/A

• Can pushing, pulling, lifting, bending or twisting cause strain?

  Yes

  No

  N/A

• Is there danger from falling objects?

  Yes

  No

  N/A

• Is excessive noise or vibration a problem?

  Yes

  No

  N/A

• Are there flammable, explosive or electrical hazards?

  Yes

  No

  N/A

• Fall hazard from one level to another or same level?

  Yes

  No

  N/A

Signatures

• Partner 1

  Sign

• Partner 2

  Sign

• Partner 3

  Sign

• Partner 4

  Sign

• Partner 5

  Sign

• Partner 6

  Sign

• Partner 7

  Sign

• Partner 8

  Sign

Comments/Discussion

• Comments/Discussion

• Add media

  Media