HOUSTON
CONTROLS
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 Number

Supervisor/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