PRE-JOB SURVEY

In order to serve you better, we need some detailed information concerning the industrial or environmental cleaning job that you wish to contract to us. Please complete this Pre-Job Survey with as much detail as possible, and send a copy of the requested documents. Please return this Survey as soon as possible to our Fax number, (303) 336-9800.

Anticipated Start Date/
Anticipated Duration
Your Company Name
Your Location
Brief Job Task Description
Your Contacts / Name / Contact Number(s) / Normal Hours
Area Management
H&S
Waste
Maintenance
Training

Request for Attachments and Instructions:

Please send/fax a copy of your company's requirements for the following areas, as soon as possible. Check the areas that you have sent.

Information

Sent

  1. A list of your company's training requirements for this job.□
  1. A copy of a site layout map showing emergency egrees routes for the work area.□
  1. A list of your company's waste disposal requirements for this job. □
  1. A list of any special cleaning considerations required for this job. □
  1. A list of any special communications requirements needed for this job. □
  1. A list of any special rescue requirements needed for this job. □
  1. A list of any special emergency requirements for this job.□
  1. Copies of all Materials Safety Data Sheets and/or chemical hazards Information for the chemicals and waste products that this job may come in contact with. □
  1. A copy of your company's Emergency Plan□
  1. A copy of your company's Confined Space Entry Program. □
  1. A copy of your Hazard Communications Program. □

Primary Hazards

Check if Job Involves / Yes / No / Permit/Instruction Attached / Comments
Hot Work (welding, cutting, etc)
Hazardous Energy Sources (LO/TO)
Rigging or Heavy Lifting
Elevated Work
Asbestos-Containing Materials
High Noise Area
Heat or Cold Stress
Confined Space Entry
Hazardous Chemicals
Ladders/Scaffolds
Powered Industrial Trucks
Respirators
Roof Work
Slippery Surfaces

Hazardous Materials Involved

Hazardous Material / NFPA Rating / CRITOR Condition(s) / MSDS Available / Monitoring Required / Dangerous Levels Exist

Atmospheric Check Requirements

Atmospheric
Checks / Pre-Entry / Periodic (Frequency) / Post-Entry / Monitor
to be Used
Oxygen
Explosive
Toxic
Work Area Temperature
Noise
Other

PPE and Other Safety Equipment Requirements

Hard Hat
Safety Glasses/Safety Goggles
Safety Shoes
Chemical Resistant Gloves
Work Gloves
Chemical Resistant Suit
Welding Protection/Laser Protection
Hearing Protection
Dust Mask
Air-Purifying Respirator (Requires Medical Monitoring and Fit-Testing)
Air-Supplying Respirator (Requires Medical Monitoring and Fit-Testing)
SCBA (Requires Medical Monitoring and Fit-Testing)
Safety Harness and Safety Line
Atmospheric Monitor
Specialized Ventilation
Communications Gear
Specialized Lighting
GFI Protection
Emergency Preparedness Equipment (fire extinguisher, first aid kit, cpr mask)
Thermal Protection--Heat or Cold
Heat Stress Prevention

Front Range Industrial Maintenance Company (FRIMCO) Pre-Job Survey Page 1 of 4