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Instrument, Electrical
Analytical Specialists / Construction Supervisor’s Package
Task Safety Analysis / Page 1 of 4
Oct 12, 2010
Revision B
(These must be filled out before work begins)
Job Number: ______Project Name/Location ______
Foreman’s Name: ______Date: ______
Type of permit Required:______Permit Number______
Personal Protective Equipment:
____ Hard HatType of Gloves Required______
____ Safety Glasses w/side shieldsType of Respirator Required______
____ Monogoggles____ Face ShieldFitted for the respirator Required ______
____ Ear Plugs ____ Ear MuffsBody Harness/with lanyards ______
____ Leather Boots____ Steel Toed BootsType of Chemical Suit ______
____ Fire Retardant Clothing
______
Emergency Knowledge & Equipment:
____ Note Wind DirectionFire Extinguisher ______
____ Evacuation RouteFire Extinguisher Inspected ______
____ First Aid AvailableFire Hose _____ Fire Blanket ______
____ Emergency Numbers PostedPost the Assembly Points ______
______
Tools:
____ Proper tools for the job____ Assured Grounding and Inspection Complete
____ All guards are in place____ Trained to use the tools properly
____ Damaged tools tagged (Do Not Use)____ Comments ______
______
Lockout / Tagout:
____ Equipment depressurized ____ Equipment de-energized
____ Lockout / Tag out required____ Try Start/ Stop Switch
____ Keys are in the Lock Box____ Lockout/ Tagout by Trained Personnel Only
____ Lockout/ Tagout Log Maintained____ Remove all Locks upon completion
______
Electrical:
____ Lockout / Tagout____ Grounded Properly
____ GFCI Test____ Assured Grounding Complete
____ Knowledge of working procedure____ Safety Protected Tools Required
______
Hotwork:Welding:
____ Combustibles Removed from area____ Welding leads inspected properly
____ Spark Containment in place____ Welding Gloves and Hood
____ Burning Goggles when using a torch____ Fire Extinguisher ____ Fire Hose
____ Fire Watch ____ Fire Blanket____ Ground lead used properly
____ Sewers covered____ Area Housekeeping Maintained
______
Equipment:
____ Proper Equipment for the Job____ Certification Card with the Operator
____ Inspection Forms Completed____ Operated by Trained Personnel Only
____ Flagman ____ Advise others of potential risks
______
Rigging
____ Proper rigging available for the job____ Knowledge of the rigging procedures
____ Properly inspected before each use____ Advise others of potential risk
______
Lifting
____ Evaluate the load get help if necessary____ Lift with your legs not your back
____ Wear gloves____ Utilize lifting tools when necessary
______
Means of Egress
____ Ladders ( Tied off)____ Scaffolds inspected
____ Aerial Equipment ____ Clear Isles / Walkways
______
Miscellaneous
____ Barricades with Tags____ Signs
____ Hole Covers____ Coordinate work activities with others
____ Temporary Handrail____ Practice GOOD HOUSEKEEPING
____ Trench/ Excavation
______
Potential Risks
____ Slip, Trips or Falls____ Inadequate Lighting
____ High Noise____ Pinch points
____ Failure to Communicate____ Heat Stress
____ Hot/ Cold Surfaces____ Sever weather
______
Please list other preventive measures to avoid risk or possible injury: ______
______
______
______
Employee’s Name
Print Name / Signature / Employee NumberSupervisor/Foreman: Audit the job on Progress: TIME: ______Initials ______
Added Job Considerations / Risk and Preventive Measures: ______
______
Close Out The Job:
Leave the Jobsite Clean and Materials Stored properly. Foreman’s Initials ______
FORM 19