HSE Concerns

Check the applicable activities in your area and evaluate safe measures:

Asbestos Exposure / Lifting Safety
Asphalt / Lock Out / Tag Out
Attendants / Marine Operations
Barricades / Material Storage
Cement / Tank / Pipe Testing
Chemical Exposure / Pinch Points
Confined Space / Powder Actuated Tools
Cranes / Lifting Equip / Power Lines
Dismantle / Demolition / Power Tools
Electrical / Pressurized Equipment
Emission Controls / Respiratory Protection
Equipment Inspection / Rigging
Erosion Controls / Toxic Exposure
Excavation / Trenching / Traffic Management
Flammable Material / Vehicles / Mobile Equip
Grinding / Waste Streams
Hazard Communication / Weather Conditions
Heavy Equipment / Working at Height
High Pressure Cleaning / Working in Cold
Hot Tapping / Working in Heat
Housekeeping / Working with Sharps
HSE Team Involvement / Others
Insects
Ladders / Scaffolds
Lawn Equipment
Lead Exposure

Involved Crew Members

Name / Signature / Post STA
Signature

Post STA

Foreman: ______

Date: ______Time: ______

Was anyone injured or did an unplanned event / incident occur today. Yes No

If yes, explain: ______

______

______

Was it reported to the HSE department?

Yes No

Is the work area clean and free of debris from the day’s work? Yes No

Have all locks been removed? Yes No N/A

Has all motorized equipment been shutdown? (Welding Machines, etc.) Yes No N/A

What problems did you have with today’s work assignment?

______

What can we do to improve performance?

______

______

Miscellaneous concerns:

______

______

Reviewers

PM or SUPT: ______

HSE Department: ______

Management Participation / Adopt-A-Crew

Name: ______

Return to the HSE Department upon completion of this task.

HSE Form 000.653.F0101

Form Date 01May2009

Project Name / Number: ______

Client Name: ______

Location: ______

Date: ______Time: ______

Task Location: ______

______

Task Description: ______

______

______

______

______

SHIFT REVIEW SIGNATURES

SignatureTimeDate

Foreman: ______

______

______

HSE Rep: ______

Gen. Foreman: ______

Note: This form is referenced in several procedures.
Safety Task Assignment

P2S’s Safety Task Assignment (STA) process significantly impacts the success of our HSE culture and the reduction of incidents. The interactive process requires that management / supervisors and employees shall:

  • Define the general task for each activity.
  • Identify known and potential HSE hazards associated with the task.
  • Determine work practices to complete the task safely.
  • Address requirements for all personal protective equipment.
  • Establish that all crew / department employees understand the above information.
  • Each crewmember is empowered to continuously participate in this process in an effort to promote our Zero Incidents culture.
  • Safely execute the task as described—if conditions change, revise accordingly.

STAs will be completed daily. Post this STA in an obvious place throughout the duration of the task. Each crewmember involved with the task will sign this STA.

Know the emergency procedure for your work area!

Personal Protective Equipment

Clothing

Chemical ResistantFire Retardant

Reflective Vest or Hand-held signal Device Tyvek

Ear Protection

Ear PlugsEar Muffs

Eye / Face Protection

Safety Glasses with Side-shields

Goggles – Cutting, Etc.Monogoggles

Welding HoodFace Shield

Fall Protection

Full-body Harness

Foot Protection

Lace up Steel Toed BootsMetatarsal

Rubber BootsElectrical Rated Boots

Hand Protection

LeatherRubber / Latex

KevlarForearm Cuffs

Barrier CreamChemical Resistant

Head Protection

Hard Hat

Respiratory Protection

Qualified to wear?

Type:

______

OtherH2S Monitor

______

Permits / Tags / Signs / Documents Required

Hot WorkCrane Lift

Trenching & ExcavationScaffolds

Confined SpaceMSDS

Line Break / Hot TappingIgnition Source Permit

Lock-Out / Tag-Out(Drilling Holes)

Signs / Barricades

Hazardous Material Compliance

Permit # ______

Permit Expires: Date______Time______

Employee Certifications Required

Crane OperatorForklift Operator

Mobile Equipment OperatorVehicle Operator

Powder-actuated Tool UserHazardous Waste

Heavy Equipment Signalman

Competent Person (excavations, confined space, scaffolds, hazardous material, heavy equipment)

Other: ______

Emergency Phone #: ______

Wind Direction: ______

Safety Shower / Eyewash Location: ______

Muster Points: 1: ______2: ______

General Task Assignment

______

______

______

______

______

______

______

______

______

Potential Hazards

______

______

______

______

______

______

______

______

______

Safe Work Practices Pertinent to Hazards

______

______

______

______

______

______

______

______

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