TEREX Take 5: Lifesaving Behaviors with LOTO

• Prepared by

• Conducted on

  Date

• Customer/Unit #

• Location City/State
  Address

• If NOT ALREADY described on your work order, Describe the task(s) you will be working on and the system(s) that will be worked on:

Take 5 Assessment

• For any failed response (noted in red) please explain in the box below the question. i.e. Can I put controls in place to manage this hazard? Attachments may be added if necessary, to better explain the situation.

• PAUSE and ask for help from your supervisor if a condition is not safe, or you cannot take action to eliminate the hazard. If a near miss occurs, report it in a timely manner to your supervisor.

• When troubleshooting, ensure that hazardous energy is controlled as soon as the problem is identified and a repair is going to take place.

• 1. I wear my seat belt when driving vehicles?

  NO

  YES

• Wearing your seatbelt is a Terex Life Saving Behavior. You must change your habit!

• 2. Do I have the proper PPE (Personal Protective Equipment) to do my job safely?

  NO

  YES

• 3. I have checked that the tools I will use are free of damage or defects and are properly guarded?

  Yes

  No

  N/A

• 4. Can I position myself in a safe zone in relation to moving equipment?

  Yes

  No

  N/A

• 5. Can I protect myself against falls from height?

  Yes

  No

  N/A

• 6. Can I park the equipment in an area where ground conditions are stable?

  Yes

  No

  N/A

• 7. Can I stand clear of the danger Zone from unstable / suspended loads?

  Yes

  No

  N/A

• 8. Can I follow my lifting plan: No Plan, No Lift?

  Yes

  No

  N/A

• 9. I have inspected my crane and rigging, and is it suitable for this lift?

  Yes

  No

  N/A

• 10. Can I work safely in the present weather conditions (weather, heat, etc.)?

  NO

  YES

• 11. My work area is clear of any obstructions (power lines, extension cords, air hoses, proper clearance for extending boom or scissor, etc.)?

  NO

  YES

• 12. Do I know where to go in the event of a facility emergency and I have access to assistance in case of an emergency for myself?

  NO

  YES

• 13. Can I prevent spills and other environmental hazards (oil spills, aerosols, etc.)?

  Yes

  No

  N/A

• 14. This job requires entry into a confined space?<br>

  No

  Yes

• Confined Space entries are not allowed, you must Pause the Job. Contact your supervisor.

• 15. Before operating equipment, can I conduct a pre-operation inspection to identify defects/issues on the equipment to be sure that I am not at risk for injury while I am operating it?

  Yes

  No

  N/A

• If additional hazards are present or possible, please explain hazard and how to manage it:

• I have training on the product family that I am working on.

• Schematics, weights (sub-assemblies that either need to be chocked or are likely to be removed during service), operator's manuals, and service/repair manuals (when provided by the manufacturer) must be readily available.

• When working on a component or system where unexpected movement could result in exposure to gravity or line of fire, support that structure by a secondary method. Secondary means not part of the system being worked on; cribbing, chocking, support with stands, etc. <br>When working under elevated structures, but the work will not impact the actual or potential movement of that structure, use controls to ensure the current state is maintained. Control examples are; isolating engine power or isolating the system by removing control voltage to the appropriate valves. <br><br>In the tasks being performed is there a possibility of movement of components from gravity?

  No

  Yes

• How will you control the possible movement from gravity?

  Select Equipment in lowest position Support under component Support with crane Blocks/Cribbing Pin/Stop Another control Not Listed

  • Equipment in lowest position
  • Support under component
  • Support with crane
  • Blocks/Cribbing
  • Pin/Stop
  • Another control Not Listed

• The controls I will put in place for gravity are not listed. Describe what you will do:

• How will you verify your control for gravity?

  Select Visually Other Verification Not Listed

  • Visually
  • Other Verification Not Listed

• The verification method I will use is not listed. Describe how you will verify control of possible movement from gravity:

• Some hydraulic systems include residual pressure even after isolation and venting. All possible actions such as activating controls, pumping brakes, etc. shall be performed before opening a system to atmosphere. When opening occurs, rags or devices to control spraying shall be used, along with face shield, safety glasses, and leather or hydraulic pressure gloves.<br><br>In the tasks being performed is there a possibility of a pressure release (examples: spring, oil, air, tension)?

  No

  Yes

• How will you control the possible pressure release?

  Select Close valve Bleed down Open relief valve/port Shield Block/Pin/Clamp Neutral Positioning Rags/Collection PPE Ignition key controlled Another control not listed

  • Close valve
  • Bleed down
  • Open relief valve/port
  • Shield
  • Block/Pin/Clamp
  • Neutral Positioning
  • Rags/Collection
  • PPE
  • Ignition key controlled
  • Another control not listed

• The controls I will put in place for pressure are not listed. Describe what you will do:

• How will you verify your control for possible pressure release?

  Select Visually Attempt movement Attempt operation Other Verification Not Listed

  • Visually
  • Attempt movement
  • Attempt operation
  • Other Verification Not Listed

• The verification method I will use is not listed. Describe how you will verify control of possible pressure release:

• When isolation of power is necessary for the task, it must be through either disconnecting the battery or use of a battery isolation switch. A lockable device and lock is required with the battery isolation switch. Control of the keys or locking/tagging ESTOPs is permitted for preventing unintended start-up, but not for energy isolation.<br><br>In the tasks being performed is there a possibility of electrical hazards (examples: power source, overhead lines, static electricity)?

  No

  Yes

• How will you control the possible electrical hazard?

  Select Disconnect power source Change work location Eliminate capacitor storage Grounding Maintain distance from power lines Another control not listed

  • Disconnect power source
  • Change work location
  • Eliminate capacitor storage
  • Grounding
  • Maintain distance from power lines
  • Another control not listed

• The controls I will put in place for possible electrical hazards are not listed. Describe what you will do:

• How will you verify your control for possible electrical hazard?

  Select Visually Attempt movement Attempt operation Other Verification Not Listed

  • Visually
  • Attempt movement
  • Attempt operation
  • Other Verification Not Listed

• The verification method I will use is not listed. Describe how you will verify control of possible electrical hazard:

• In the tasks being performed is there a possibility of motion (examples: rotation, pushing, sliding, pulling, rolling, pinching, crushing, striking)?

  No

  Yes

• How will you control the possible motion hazard?

  Select Disconnect power Block, Clamp, Pin Neutral position Parked & Chocked Ignition key controlled Another control Not Listed

  • Disconnect power
  • Block, Clamp, Pin
  • Neutral position
  • Parked & Chocked
  • Ignition key controlled
  • Another control Not Listed

• The controls I will put in place for possible motion are not listed. Describe what you will do:

• How will you verify your control of possible motion?

  Select Visually Other Verification Not Listed

  • Visually
  • Other Verification Not Listed

• The verification method I will use is not listed. Describe how you will verify control of possible motion hazard:

• In the tasks being performed is there a possibility of temperature extremes (examples: hot surface, hot oil, hot water, extreme cold)?

  No

  Yes

• How will you control the possible temperature hazard?

  Select Cool down time Personal Protective Equipment Disconnect Power Warm up time Another control Not Listed

  • Cool down time
  • Personal Protective Equipment
  • Disconnect Power
  • Warm up time
  • Another control Not Listed

• The controls I will put in place for possible temperature hazard are not listed. Describe what you will do:

• How will you verify your control of possible temperature hazard?

  Select Visually Temperature gauge Amount of time passed Thermometer Another Verification Not Listed

  • Visually
  • Temperature gauge
  • Amount of time passed
  • Thermometer
  • Another Verification Not Listed

• The verification method I will use is not listed. Describe how you will verify control of possible temperature hazard:

• In the tasks being performed is there a possibility of chemical hazards (examples: acid, oils, fuel, emission, flammable)?

  No

  Yes

• How will you control the possible chemical hazard?

  Select Personal Protective Equipment Containment Ventilation Shielding Equipment shut down Flushing Absorbent Another control Not Listed

  • Personal Protective Equipment
  • Containment
  • Ventilation
  • Shielding
  • Equipment shut down
  • Flushing
  • Absorbent
  • Another control Not Listed

• The controls I will put in place for possible chemical hazard are not listed. Describe what you will do:

• How will you verify your control of possible chemical hazard?

  Select Expected Quantity Flows No Flow/Flow Stops Gauge Visual Verification Method Not Listed

  • Expected Quantity Flows
  • No Flow/Flow Stops
  • Gauge
  • Visual
  • Verification Method Not Listed

• The verification method I will use is not listed. Describe how you will verify control of possible chemical hazard:

• What are the specific triggers to Pause this Job and re-evaluate?

  Select Unexpected Movement Electrical tingle Sparks Oil flow/spray Headache or feel ill Burn to skin Severe Weather Can't park or rest component People around equipment Traffic in work area Connection won't budge After making a mistake Other Not Listed

  • Unexpected Movement
  • Electrical tingle
  • Sparks
  • Oil flow/spray
  • Headache or feel ill
  • Burn to skin
  • Severe Weather
  • Can't park or rest component
  • People around equipment
  • Traffic in work area
  • Connection won't budge
  • After making a mistake
  • Other Not Listed

• I have additional Job Pause trigger(s) not listed. Describe: