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PRE-TASK PLAN
Date :
*
CONTRACTOR :
*
SUPERVISOR :
*
JOB DESCRIPTION:
*
LOCATION :
*
DOES TASK REQUIRE SPECIAL TRAINING ?
Yes
No
(Pre-TASK PLAN CHECKLIST)
EXCAVATION
SHORED/SLOPED
Yes
No
LADDER PROVIDED
Yes
No
DAILY INSEPECTION
Yes
No
OVERHEAD WORK OR FLOOR OPENING
FIXED BARRICADES
Yes
No
DANGER (TAPE)
Yes
No
CAUTION (TAPE)
Yes
No
BARRICADE/I.D. SIGNS
Yes
No
SIGNS
Yes
No
HOLE COVER
Yes
No
HANDRAILS
Yes
No
HAZARDS
FALL POTENTIAL
Yes
No
PINCH POINTS
Yes
No
ELECTICAL SHOCK
Yes
No
HOUSEKEEPING
Yes
No
SLIP-TRIP
Yes
No
FLYING PARTICLES
Yes
No
MANUAL LIFTING
Yes
No
SHARP OBJECTS
Yes
No
ENVIRONMENTAL
Yes
No
MSDS REVIEWED
Yes
No
WELDING/HOT WORK
SHIELDS
Yes
No
FIRE BLANKET
Yes
No
CYLINDERS SECURED
Yes
No
COMBUSTIBLES MOVED
Yes
No
SPARKS CONTAINED
Yes
No
FIRE EXTINGUSHER
Yes
No
FLASHBACK ARRESTOR
Yes
No
PERMITS
HOT WORK
Yes
No
CONFINED SPACE
Yes
No
EXCAVATION
Yes
No
CRITICAL LIFT PLAN
Yes
No
LO/TO
Yes
No
TRAFFIC PLAN
Yes
No
PERMIT DISPLAYED
Yes
No
PERSONAL PROTECTIVE EQUIPMENT
GLOVES
Yes
No
BOOTS
Yes
No
APPROPRIATE EYE PROTECTION
Yes
No
FRESH AIR FAN
Yes
No
EAR PROTECTION
Yes
No
SAFETY HARNESS
Yes
No
BURNING GOGGLES
Yes
No
TRAFFIC VEST
Yes
No
RESPIRATOR
Yes
No