Section: 14-03-00 HAZARD IDENTIFICATION & ASSESSMENT

Revision: 01-2020/01/27 Shift Pre-Task Plan (PTP)

Date M T W T F S S Day# Day Shift Night Shift Supervisor / Foreman ICC Job #
Plant & Location Location of Task Safety Supervisor
Today’s weather forecast: Wind:
Description of the work to be performed: Competent persons:

#1 EVALUATING YOUR WORK AREA & TASKS #2 Potential Hazards #3 Personal Protective Equipment #5 Housekeeping #11 Hot Work / Welding-Burning
√ or X all the appropriate box(s) Yes No √ or X all the appropriate box(s) √ or X all the appropriate box(s) Keep passageways clear Permit completed
Have you evaluated the hazards for this Cell Phones X Hard hat X Keep tools in proper places Final fire guard inspection
task?
Elevated work Safety glasses X
If Yes – Complete section # 2 Keep debris contained and/or Proper PPE
Do you have the PPE needed for this task? Falls from elevations Safety boots X in its proper place Hoses & leads inspected
If Yes – Complete section # 3 & 3A Overhead work Long pants & 4” sleeves X Hoses, cords, etc. elevated Hoses & leads elevated
Does your task involve mobile equipment? Falling objects Appropriate gloves for task(s) X and/or out of walkways Proper grounding
If Yes – Complete section # 4 Windy Conditions Harness w/ double lanyard X Materials properly/safely Proper scaffold cable isolation
Have you walked your work area? Manual lifting Hi Viz clothing / vest stacked Proper cylinder storage
If Yes – Complete section # 5 Particles in eyes Clear face shield (as needed) Maintain a vehicle access Cylinders properly secured
Are the required material and tools provided? Sharp objects or tools Ear plugs (as needed) Keep garbage emptied # 12 Ladders
Ladders Dust mask (as needed) #6 Lock-out / Tag-out Chimney Scaling ladders
Is an SDS review necessary for this task?
Rigging Paper coveralls Personnel roster Inspected
Any equipment needs “Lock-out / tag-out”? High noise levels Welding hood Control room lock Properly secured w/ (2) #9 wires
If Yes – Complete section # 6 Scaffolding Burning goggles / shield Lock box / satellite box Proper safety line installed
Does your task involve a scaffold? Heat exhaustion / stress Fire-retardant clothing (FRC) Locks secured & tagged Step & Extension Ladders
If Yes – Complete section # 7 Pinch points Ear muffs Blinds/blank offs in place Inspected
Does this task involve a crane? Thermal burns Splash goggles Energy isolated or released Tied off at the top
If Yes – Complete section # 8 Mobile equipment Rubber / chemical gloves Equipment verified Proper angle
Does your task require a barricade? Trips & slips Life jacket #7 Scaffold Extends 3’ past upper level
If Yes – Complete section # 9 Complacency Other: Daily inspection # 13 Readiness
Does this task involve a confined space? Hand tools Respirator Properly tagged & signed Alarm awareness
If Yes – Complete section # 10 Power tools Respirator cartridge type: Tied off / Secure Evacuation routes established
Does this task involve “Hot Work”? Electrical shock 100% Tie off above 6’ (4’) X Access open Muster area established
If Yes – Complete section # 11 High pressure air / water Drink your fluids X Proper safety line installed Wind direction noted
Is air monitoring required? Confined space Daily inspections X Wheels locked (if used) First Aid kits established
Does your task involve using ladders? Inhalation hazard Obey plant speed & wear seatbelts X #8 Crane Eye wash / showers established
If Yes – Complete section # 12 Inadequate access No cell phones when operating Outriggers fully extended SDS available 14-03-0& reviewed
X
Are any permits required for your task? Lock-out / tag-out equipment or vehicles Pre-inspection completed Emergency Phone #’s posted
Hot Hazardous chemicals # 3A Designated PPE Lift plans completed Fire protection established
Confined Chemical burns Proper rigging Spill kits established
Excavation Chemical spills Swing radius barricaded Designated entry watch
Is the crew informed on proper emergency Critical lift Communications verified Safe-Escape established
readiness? If Yes –Complete section # 13 Fire / explosion #9 Barricades # 14 Silica
Will the work expose employees to silica? Nearby electrical lines Proper color & type Silica Exposure Control Plan
If Yes – Complete section # 14 Nearby railroad tracks #4 Mobile Equipment Proper signage & tags onsite & reviewed with crew
Does your task require special training? Line breaking Daily inspections Proper location Restricting access to unauthorized
Are you working around live systems? Radiation Use a spotter when backing up # 10 Confined Space personnel is barricaded
Excavations Spotter wearing Hi Viz vest Permit completed Silica signage in
Additional comments Poor housekeeping Operator trained & certified Personnel roster place on barricade
Plant operations No cell phone use when operating Attendant assigned
equipment or driving vehicles Air monitor calibration up to date

Change of Task during the day can be added to the back of this form Page 1 of 2
Work Crew Sign-off on back of this form
 Today’s Tasks Changed To:

Retrieval method in place

Required Action to Eliminate or Control the
Description of the Work to be Performed Hazards Associated with Each Step
Hazard

Required Action to Eliminate or Control the

Description of the Work to be Performed Hazards Associated with Each Step
Hazard

Summary of Today’s Work

Today’s weather was: Hi ° Lo ° Wind

WORK CREW SIGN-OFF (printed name & signature)
1 16
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4 19
5 20
6 21
7 22
8 23
9 24
10 25
11 26
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13 28
14 29
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 Section: 14-03-00 HAZARD IDENTIFICATION & ASSESSMENT
Revision: 01-2020/01/27 Shift Pre-Task Plan (PTP)

Change of Task during the day can be added to the back of this form Page 3 of 2
Work Crew Sign-off on back of this form