Title Page
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Site conducted
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Job# / # del Trabajo
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Date and Time / Dia y Fecha
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Supervisor:
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Completed by / Completado por
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Location
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PRE-TASK SAFETY REVIEW (Reviso de Seguridad Pre-Trabajo)
PRE-TASK SAFETY REVIEW (Reviso de Seguridad Pre-Trabajo)
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Prior to Start of Task
- Review Project Safety Plan, if applicable.
- Understand and review the scope of work with the entire crew.
-Identify and communicate task hazards to all crew members, subcontractor, and affected personnel.
-Determine training requirements of the crew, If any.
-Review task Specific JHA
-Ensure necessary Personal Protective Equipment (PPE) and tools are available and ready to use. (i.e traffic control, fall protection, hand power tools)
-review all SDS for chemicals involved with task.
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Antes del inicio de la tarea
- Revisar el plan de seguridad del proyecto, si es aplicable
- entiendad y revisen la magnitud del trabajo con el groupo.
-Identificar y comuniquen todos los peligros de el trabajo con el grupo, el subcontratista y el personal afectado.
-Determinar si se necesitan entrenamientos.
-Revisar que el JHA sea echo por el trabajo especifico
-Asegúrese de que el Equipo de Protección Personal (EPP) y las herramientas necesarias estén disponibles. (Proteccion de Caida, Control de Trafico, Herramienta de Mano)
-Revisar todas las hojas SDSpara productos químicos involucrados con la trabajo.
LIST EMPLOYEES COVERED BY THIS PTSR (Lista de Empleados cuviertos por este Reviso de Seguridad)
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Click here to add Employee (Aga Clic si es Nuevo al Trabajo)
Employee
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Employee name? (Nombre del Empleado)
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New to Job or Company?
IMPORTANT TASK INFORMATION (Datos Importantes Sobre el Trabajo)
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Click to enter information
GENERAL TASK (Trabajo General)
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Select all applicable tasks (Seleccione todas las tareas aplicables)
- Wall Forming / Formando Paredes
- Decking
- Beam Forms / Formas de Bordes
- Rigging & Hoisting / Rigiando & Alzando
- Re-Shoring
- Concrete Placement / Sentar Cemento
- Wall Erection / Ereccion de Paredes
- Pan Forms / Formas de Bandeja
- Stripping / Demolucion
- Clean up / Limpiesa
- Edge Forms / Formas de Viga (Beam)
- Trenching / Trabajando en Zanjas
- Shoring Erection / Ereccion de Shores
- Rebar Work / Trabajando con Varilla
- Other / Otros
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Enter Info
WRITTEN PLANS (Planes Escrito)
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Select all applicable.
- Fall Protection / Proteccion de Caidas
- Site Specific Safety Plan / Plan de Seguridad Especifico con el Sitio
- Emergency Action Plan / Plan de Emergencia
- Blueprints & Form Drawings / Planos
- Stripping Plan / Plan de Demolucion
- Traffic Control / Control de Trafico
- Re-shore Plan / Plan de Re-Shore
- Lift Plan / Plan de Levante
EQUIPMENT UTILIZATION (Utilizacion de Equipe)
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Select all Applicable
- Forklift
- Boom Lift
- Inspection: Completed and Documented
- Crane / Grua
- Scaffolding / Adamio
- Scissor Lift
- Strip Wagon / Carreton de Demolucion
- Other / Otro:
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Enter Info
INSPECTIONS (Inspecciones)
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Select all Applicable
- Rigging
- Ladders / Esqualeras
- Tag Line
- Machinery / Maquinaria
- Other / Otro
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Enter Info
POTENTIAL HAZARDS (Peligros Posibles)
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AIRBORNE HAZARDS:
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Check all that apply
- Lead
- Asbestos
- Air Quality
- Metal Frame
- Dust / Silica
- Chemical
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PHYSICAL HAZARDS:
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Check all that apply
- Falling Objects
- High Noise >90dB
- Work Over / Near Water
- Head Hazards
- Face Hazards
- Hand Hazards
- Temperature Extremes
- Walking / Working Surfaces
- Impact from/ By
- Sharp Objects
- Eye Hazards
- Hot Surfaces
- Heavy Lifting
- Foot Hazards
- Radiation
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TASK SPECIFIC HAZARDS
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Check all that apply
- Moving Machinery
- Floor/Wall Openings
- Climbing Ladders
- Pinch/ Crush Points
- Fall from heights >6ft
- Excavations / trenching
- Machinery Operations
- Raising/ Lowering Materials
- Confined Space Entry (Contact Safety Dept.)
- Traffic
- Slip/Trip/Falls
- Scaffolding
- Electrical Energy
- Hand/ Power Tools
- Impalement Dangers
HAZARD MITIGATION / ELIMINATION
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PPE (Personal Protective Equipment)
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Select all that apply
- Head Hard Hat
- Respiratory
- Ear Plugs
- Bionic Face Shield
- Reflective Vest
- Hand Gloves
- Safety Glasses / Goggles
- Face Shield
- Feet
- Seat Belts
- Skin
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FALL PROTECTION PREVENTION
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Select all that apply
- Full Body Harness
- Lanyards
- Retractable Lines
- Positioning Chains
- Leading Edge Protection
- Guard Rails / Barricades
- Fall Prevention Plan
- Horizontal Life Line
- Hole Covers
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FIRE PROTECTION
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Select all that apply
- Fire Protection
- Proper Fuel Storage
- Fire Retardant Blankets
- Proper Handling Storage Use of Flammable Materials
- Fire Watch
- Proper Size
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EXCAVATION / TRENCHING
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Select all that apply
- Competent Person
- Entry / Escape Ladders
- Shoring / Sloping / Benching
- Existing Underground Utilities
- Other
- Barricades / Plating
- Signages / Cones
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Enter Info:
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EMERGENCY & MEDICAL
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Select all that apply
- First Aid Kit
- Eye Wash Station
- Clinic / Emergency Route / Location
- First Aid/ CPR training
- SDS On Site/ Location
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TRAFFIC & PEDESTRIAN CONTROL
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Select all that apply
- Signage & Barricades
- Traffic Control Plan
- Lane Delineators
- Arrow Boards
- Flag Man
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ELECTRICAL SOURCES
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Select all that apply
- Locked Out / Tagged out
- Corded Tools Inspected
- Cords Laid Out Safety
- Overhead Power Lines Identified & Marked
- Underground Lines Identified & Marked
- GFCI in use
- Cords Inspected
- Proper Grounding Assured
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HEALTH, HYGIENE, & HOUSEKEEPING
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Select all that apply
- Trash & Debris Contained
- Heat Stress Monitored
- Restroom Available
- Drinking Water Available / Sealed & Dated
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NEAR MISS REPORT
-Focus Daily on Safety
-ALL incidents, injuries and near misses MUST be reported IMMEDIATELY! -
Click here to add Near Miss Report
Near Miss
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Date
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Who?
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What?
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When?
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Where?
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Why?
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Correction Actions Taken
COMPLETION
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Pre- Task Plan Leader Name and Signature:
