Skanska Pretask Planning Playbook
Skanska Pretask Planning Playbook
Skanska Pretask Planning Playbook
You will find attached to this document a collection of actual job site pre-task plans organized
by division. Some are very minimal and some are outstanding, yet each of these represents the
documentation side of what is being done at our projects. Of course the more crucial side of pre-
task planning is how inter-active the discussion is, and that a true culture of planning is present
at every project.
The idea behind this collection of pre-task plans is for you to use as a reference and a training aid
at our projects. They are not meant to represent what should be done, but to demonstrate what
is actually being produced at our projects today. Please feel free to use these as needed, and
recognize that as we continue to improve our ability to plan at every project, we will absolutely
continue to reduce accident frequency and severity, and we will achieve our goal of zero injuries!
Van
Pre-Task Plan Playbook
Table of Contents
Division 1 - General Requirements
Division 2 - Site Construction
Division 3 - Concrete
Division 4 - Masonry
Division 5 - Metals
Division 6 - Wood and Plastics
Division 7 - Thermal and Moisture Protection
Division 8 - Doors and Windows
Division 9 - Finishes
Division 10 - Specialties
Division 11 - Equipment
Division 12 - Furnishings
Division 13 - Special Construction
Division 14 - Conveying Systems
Division 15 - Mechanical
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Job Name:
Foreman Name: Task Description:
Date:
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Pre-Task Plan Playbook
Table of Contents
Division 1 - General Requirements
Division 2 - Site Construction
Division 3 - Concrete
Division 4 - Masonry
Division 5 - Metals
Division 6 - Wood and Plastics
Division 7 - Thermal and Moisture Protection
Division 8 - Doors and Windows
Division 9 - Finishes
Division 10 - Specialties
Division 11 - Equipment
Division 12 - Furnishings
Division 13 - Special Construction
Division 14 - Conveying Systems
Division 15 - Mechanical
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Job Name: La Joya High School
Foreman Name: Rudy Elizondo Task Description: Housekeeping, guitar handrails
Date: 4/6/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 PPE 1 Laides 1 PPE
2 Preparar material 2 Cortadas 2 Buenas practices de trabajo
3 Rensar herramienta 3 Tropiezos 3 No cambiar metodo de trabajo
4 Inspeccioner skytrak 4 Resbaladas 4 Blogurar area de trabajo estes necesario
5 Inspeccioner generador 5 Cargando cosas pesadas 5 Revisar area de trabajo
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Jobel Salazar
Bentsen Palm Road
Foreman: Rudy Elizondo General Foreman: Rudy Elizando
Emergency Numbers
Emergency Phone: Crew Members: Francisco Montoya Gelecio Cuellan Isidio Escobar
Emergency Radio: 911 Jose Mozuera
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Install Sky Climber power cord 1 Fall hazard 1 Use safety harness
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Main St. & St. Antione
Foreman: Frank Watson General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Doug Donald Ken Harlan Mark Crowe
Emergency Radio:
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Go up with scaffold 1 Falling material 1 100% Tie off
2 Pack Material 2 Tripping 2 House keeping
3 Pick points 3 Drink water
4 Falling personnel 4 PPE
5 Alertness
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Front Gate
Foreman: Jorge Rivas General Foreman:
Emergency Numbers
Emergency Phone: (281) 733-3421 Crew Members: Chris Vargas Eric Sanford Jonathan Pitt
Emergency Radio: 142*600*96 Francisco Banks Daniel Riviera Davidson Allen
Fire: Jeff Williams
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Brought all the material from the building to 1 Falling personnel 1 100% Tie off
the yard
2 Tripping 2 House keeping
3 Back injury 3 PPE
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Front Gate
Foreman: Jorge Rivas General Foreman:
Emergency Numbers
Emergency Phone: (281) 733-3421 Crew Members: Chris Vargas Eric Sanford Jonathan Pitt
Emergency Radio: 142*600*96 Francisco Banks Daniel Riviera Davidson Allen
Fire: Jeff Williams
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Go up with scaffold 1 Tripping 1 100% Tie off
2 Pack material 2 Back injury 2 House keeping
3 Falling material 3 PPE
4 Falling personnel 4 Drink water
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Front Gate
Foreman: Jorge Rivas General Foreman:
Emergency Numbers
Emergency Phone: (281) 733-3421 Crew Members: Chris Vargas Eric Sanford Jonathan Pitt
Emergency Radio: 142*600*96 Francisco Banks Daniel Riviera Davidson Allen
Fire: Jeff Williams
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Clear, strip the swales 1 Electric line 1 Caution
2 Gas line 2 One (1) person around the strip
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Lockwood Street
Foreman: Miguel Vega General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Daniel Anaya Joseph P. Vega
Emergency Radio: Giovanni Banda
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Clear and stock pile 1 Gas line 1 Localize the gas line
2 Electric line 2 Don’t work too close to the electric line
2 Strip and stock pile 3 Burn cable underground
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Lockwood Street
Foreman: Miguel Vega General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Daniel Anaya Joseph P. Vega
Emergency Radio: Giovanni Banda
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Clear, cut fill 1 Gas line 1 Localize the lines
2 Cut a pond 2 Electric lines 2 Caution in the line
3 Load at trees
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Lockwood Street
Foreman: Miguel Vega General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Daniel Anaya Joseph Apacheco Felipe Hernandes
Emergency Radio: Giovanni Banda Benito Mata Jose Ava
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Excavation 1 Gas 1 Locate lines
2 Power lines
3 Water line
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
North parking lot
Foreman: Guadalupe Hernandez General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Felipe Aconande Apolinar Valerio
Emergency Radio: Hector Hernandez Elder Holez
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Clear, load the trees 1 Gas line 1 Localize the electric and gas lines
2 Electric lines
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Lockwood Street
Foreman: Miguel Vega General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Juan ZUmaga Jose Ava
Emergency Radio: Giovanni Banda D. Araya
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Load trees 1 Electric line 1 Caution to digger
2 Cut and fill 2 Gas line 2 Localize the line
3 Load trucks with dirt
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Lockwood Street
Foreman: Miguel Vega General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Juan Zuniga Jose Ava
Emergency Radio: Giovanni Banda D. Aruya
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Load trees 1 Power line 1 Localize the lines
2 Made the construction entrance 2 Gas line
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Lockwood Street
Foreman: Miguel Vega General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Juan Zuniga
Emergency Radio: Giovanni Banda
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Clear strip the side stockpile 1 Power line 1 Localize the underground
2 Underground utilities
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Lockwood Street
Foreman: Miguel Vega General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Adjust curb inlets 1 Damaged chains 1 Inspect chains
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Bubba Lanphise
East parking lot
Foreman: General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Ruben Rivera Brandon Soto Ryan Sanders
Emergency Radio: Alberto Flores Gustavo de la Cruz
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Stay out of the swing radius, never overturn. Keep
1 Loading Dirt 1 Swing radius – pinch point 1
driver in truck.
Spotter when needed,
2 Dumping dirt 2 Rollover, congested area 2
dump on level ground
Spotter and good eye contact
3 Digging or grading 3 Congested area 3
Give one call
4 Getting on and off machines 4 Slippery conditions 4 3 points of contact, keep steps clean
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
BCBS
Foreman: Steven Ball General Foreman:
Emergency Numbers
Emergency Phone: 421-1144 Crew Members: Dan Browning
Emergency Radio: John Pizzaro
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Lifting and adjusting materials and equipment 1 Muscle strain, pinch points 1 Proper lifting techniques, work gloves, PPE
2 Concrete equipment to electric power 2 Shock 2 Inspect tools prior to use, GFCI, Dielectric gloves if
cutting conduit
3 Use hydraulic power pack 3 Hydraulic leaks, slips/falls 3 Inspect hydraulic hoses, ensure hyrdraulic couplings
are connected properly
4 Core/saw concrete 4 FOE, Noise 80db, dust, slip 4 Proper PPE, apply H2O to cut, vacuum slurry
5 Remove cores from floor 5 Strains, open hole 5 Proper lifting, cover holes, red tape work area
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Housekeeping
Moving Object/Equipment Caught In/Between
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
be present on the job site? Obstruction/Interference Other Was site cleaned up and secured after work?
YES NO
Yes No **See AMS site trailer
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Jason P. Jordan
Skanska site trailer
Foreman: General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio: 911
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 3 - Concrete
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Precision Job Name: Georgia Military College
Foreman Name: McCarty Task Description: Unload Rebar
Date: 4/13/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Climbing trailer 1 Fall 1 3 points of contact
2 Moving steel 2 Hit by 2 Proper rigging
Cuts to hands Stand “clear” of load
Gloves
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: D. McClarty
Main gate
Foreman: General Foreman: Marcos Colondre
Emergency Numbers
Emergency Phone: 911 Crew Members: Ricardo Castillo Wil Antonio Gaby
Emergency Radio: 911 William Bryant Nathan Morrow Olvin Caliz
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 3 - Concrete
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Job Name:
Foreman Name: Manuel Del Rio Task Description: Formear la pared y chapear-rubear
Date: 6/10 Limpiar el area de trabajo
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Se puede caer la persona que esta Sujetandose con las 2 lineas de arnes y la cadena
1 Formear la pared 1 1
trabajando arriba estando 6’ arriba del suelo
Puede perder un ojo o dañarse los pulmones Debe usar lentes de proteccion o careta y mascarilla
2 Chapear y rubear otra 2
o oides para el polvo y usar earplugs
Se puede enterrar un clavo o caer con Tener cuidado donde pisa y poniento cada material
3 Limpiar el trabajo 3 3
material tirado en respectiva area o tirarlo al dumpster
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Don McCorty
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 3 - Concrete
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Job Name: GMC
Foreman Name: J Luis Resendiz Task Description: Alistar la tierra para la grava
Date: 5/18/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Alistar el piso 1 La bobcat 1 Estar alejando de la maquina
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
La puerta principal
Foreman: Luis Resendiz General Foreman:
Emergency Numbers
Emergency Phone: Crew Members: Juan Resendiz Mario Resendiz Carlos Lopez
Emergency Radio: Sergio Gomez Manuel Del Rio
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 3 - Concrete
Job Hazard Analysis
Contractor: Location:
1.1.2 Stand clear of straps and loads while releasing tension on the tie downs.
1.1.3 Use a forklift or crane to hold materials that have shifted while releasing
tie downs.
1.2.3 Ensure manufacturers tag is on the rigging and the rigging is sufficient for
the loads intended.
1.2.4 Rigging without manufacturers tag must be removed from service and
destroyed.
1.3 Personnel injured by forklift operation 1.3.1 Only qualified trained operators shall operate equipment. Each person
authorized to operate equipment shall have documentation of
qualifications filed with the site safety supervisor.
1.4 Back injury 1.4.1 Workers must be trained in proper body mechanics for lifting and moving
heavy materials.
1.4.2 Workers must use equipment to move heavy loads to the greatest extent
possible.
2.1.2 Material should be stored in areas away from main vehicular traffic.
2.2 Structural failure of forms or storage 2.2.1 Know established load limits of forms and surfaces where materials will
surface be stored and do not exceed limits.
3 Installing cables 3.1 Back and/or personal injuries 3.1.1 Personnel shall be trained in proper body mechanics for lifting and
handling of cables.
3.1.3 Heavy or awkward loads must not be handled by a single worker. Use
mechanical equipment to the best advantage and/or get help from a
coworker.
3.2 Rigging failure 3.2.1 Know established weights of materials to be hoisted or moved.
3.2.2 Inspect rigging prior to use. Remove from service and destroy and
rigging not meeting the manufacturers specifications.
3.3 Personnel being struck by cable ends 3.3.1 Worker installing cables must be aware of cable ends and the potential
hazard which exists.
3.3.2 Workers should tie the free end of the cable to the cable prior to
beginning the installation. End should remain tied until cable is rolled out
in its entirety and a controlled release can be implemented.
3.4 Personnel injured while moving or 3.4.1 Workers required to relocate re-steel must use extreme caution to
relocating re-steel prevent personal injury.
3.4.2 Workers must use levers and lifting devices to the greatest extent
possible to help prevent back injuries.
3.4.3 Re-steel may need to be untied, moved and retied rather than trying to
move whole units.
3.5.2 Workers and inspector shall inspect all cables prior to the placing of
concrete and damaged cables shall be repaired per manufacturer’s
recommendations.
3.5.3 Any worker knowingly damaging a cable shall immediately notify the
foreman responsible for the post tensioning operation so repairs can be
made.
4 Stressing of cables 4.1 Equipment failure 4.1.1 Workers authorized to stress cables shall be trained in the proper use
and function of all equipment.
4.1.3 All equipment shall be compatible with each other and/or marked so
crews know exactly which units are compatible.
4.2 Unauthorized personnel in the work zone 4.2.1 Warning lines and signs shall be installed to isolate the area immediately
involved with the stressing cables.
4.2.2 A safety meeting shall be held for all hands on the project to discuss the
hazards of stressing cables. Workers shall be instructed to stay out of
ears marked with warning lines and signs.
4.2.3 Workers assigned to perform the stressing operation shall watch out for
unauthorized workers walking into the area.
4.3 Personal injury (back, hands, eyes) 4.3.1 Workers shall be provided and shall wear all appropriate personal
protective equipment. Specifically eye protection, gloves and a hard hat.
4.3.2 Workers shall work in pairs and assist each other in the lifting and moving
of heavy equipment.
4.3.4 Workers shall never stand in such a position as to be in the direct line
with the cable being stressed.
4.3.5 Workers shall never stand directly over the ram or the cable during the
stressing operation.
4.4 Cable breaking 4.4.1 Workers shall inspect cable, wedges, and head prior to stressing.
4.4.2 Cables shall not be stressed past the recommended levels outlined by
the structural engineer.
4.4.3 Any cable pilled beyond the recommended limits shall be marked and the
engineer notified. The onsite inspector shall be notified immediately to
establish a plan of action.
4.5 Cable breaking through the slab surface 4.5.1 Warning lines shall be established on the slab to isolate the area where
stressing is in progress.
4.5.2 No workers shall be allowed to be on the slab and inside of the warning
lines while cables are being stressed unless directly involved with the
stressing operation.
4.5.3 No worker shall be within 5 feet of either said of the cable being stressed.
4.6 Re-stressing of cable after initial stressing 4.6.1 Re-stressing of cables should not be performed without the knowledge
and set and permission of the site inspector and/or structural engineer.
4.6.2 The lead person on the stressing crew should be the person in charge of
the operation and shall directly oversee all work.
5 Cutting excess cable 5.1 Sparks and/or cable falling in workers 5.1.1 Flag off the area directly below the area being worked. Post signs
below notifying workers of “Workers Overhead”
5.1.2 Fire watch may need to be placed below the work area to ensure
unauthorized workers do not enter the area.
5.2 Cable becoming de-stressed 5.2.1 Worker assigned to burn off cable ends shall be properly trained in the
work. He/she shall be knowledgeable in the sign and warnings of a
potential failure.
5.3.2 The worker shall be properly trained in the use and operation of the
extinguisher.
5.3.3 A fire watch may be necessary on levels below the actual work area.
5.3.4 All combustible materials shall be removed or protected from flames and
sparks.
5.3.5 All burning shall be stopped 30 minutes prior to the end of the shift and
the fire watch shall remain on duty till the end of the shift.
6 Slab work after concrete 6.1 Drilling, cooling and/or sawing 6.1.1 No drilling, coring and/or sawing shall be performed without the written
has been placed permission of the Skanska Superintendent or his designated
representative.
6.2 Powder actuated fasteners 6.2.1 Powder actuated tools shall not be allowed on this project without the
knowledge of the Skanska Superintendent of his designated
representative.
7 Post tension investigation 7.1 Cable and its components exiting the slab 7.1.1 Personnel shall be trained in proper body mechanics for lifting and
and repair via path of least resistance (path handling cables.
unknown) and coming into contact with
employees
7.1.2 Workers should wear gloves to the greatest extent possible.
7.1.3 Workers relocating post tension cables must use extreme caution to
prevent personal injury.
7.1.4 All workers assigned to work in the area where cables are installed shall
be trained in the potential hazards associated with a cable that has been
damaged.
7.1.5 Workers authorized to work with the stressed cables shall be trained in
the proper use and function of all equipment.
7.1.6 Warning lines and signs shall be installed to isolate the area immediately
involved with the post tensioned cables.
7.1.8 Workers assigned to perform the operation shall watch out for
unauthorized workers walking through the area.
7.1.9 Workers shall be provided and shall wear all appropriate personal
protective equipment. Specifically eye protection, gloves and a hard hat.
7.1.10 Workers shall never stand in such a position as to be in direct line with
the cable being stressed.
7.1.12 Any alterations or repairs should have a full engineer of record prior to
work commencing.
7.1.13 A 5”x5” steel plate should be placed on concrete directly in the line of
cable to be stressed during repairs.
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Laying CMU, housekeeping 1 Falls/trips/slips 1 Good work practice
2 Moving materials 2 PPE
3 Lay outs & Chalk lines
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Report to entrance gate inside of fence Superintendent: Charlie Richardson
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 4 - Masonry
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Bas Masonry Job Name: Music Building
Foreman Name: Atilano Limon Task Description: Brick Laying
Date:
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Assembling scaffolds 1 Falls/ slips/ trips 1 Use proper safety equipment: harness/ glasses
2 Laying brick 2 Falls/ debris/ cuts/ falling debris 2 Wear proper PPE: glasses/ gloves/ harness
Tape area for falling debris
3 Mixing mortar 3 Debris 3 Wear glasses/ dust mask/ shield
4 Cutting brick 4 Cuts/ debris 4 Use proper PPE: glasses/ shield/ gloves
5 Operating 5 Run into other equipment of pedestrians 5 Use spotter to watch out for surrounding machines
Fall off machine and pedestrians
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Sergio Lopez
Meet in front of building
Foreman: Atilano Limon General Foreman: Ignacio Baraga
Emergency Numbers
Emergency Phone: 522-7388 Crew Members: Jaime Gonzalez Jose R. Valdez Raul Hernandez
Emergency Radio: 372-3077 Erasmo Garcia Luis Wagner Juan Hernandez
Fire: Jeremiah S. Jorge Gonzalez Martin Ledezma
Other: 911 Use the Back of this Form to List Any Additional Steps and Other Information
Division 4 - Masonry
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Bamfield Job Name: CSU
Foreman Name: Task Description: Lay Brick
Date: 5/7/08
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Build scaffold 1 Falls 1 Proper training and install
2 Mix mortar 2 Dust 2 100% PPE
3 Cut brick 3 Chips and dust 3 Wet cut and 100% PPE
4 Stock scaffold 4 Back injury 4 Proper lifting technique
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Division 4 - Masonry
Pre-Task Plan Playbook
Table of Contents
Division 1 - General Requirements
Division 2 - Site Construction
Division 3 - Concrete
Division 4 - Masonry
Division 5 - Metals
Division 6 - Wood and Plastics
Division 7 - Thermal and Moisture Protection
Division 8 - Doors and Windows
Division 9 - Finishes
Division 10 - Specialties
Division 11 - Equipment
Division 12 - Furnishings
Division 13 - Special Construction
Division 14 - Conveying Systems
Division 15 - Mechanical
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: H&R Industrial Job Name: BCBS
Foreman Name: Randy McCarty Task Description: Tube Steel for Video Screen
Date: 3/16/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Go over pre-task
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Randy McCarty
Parking lot, front building 1
Foreman: General Foreman:
Emergency Numbers
Emergency Phone: Earlanger Crew Members: Steve Sour Chad Crumples
Emergency Radio: Dale Bugett
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 5 - Metals
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Dixie Erectors Job Name: Clayton State
Foreman Name: Kenny Task Description: Steel Erection
Date: 4/21/08
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Erect Steel 1 Fall 1 100% tie off, PPE
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Kenny Cauthon
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 5 - Metals
Job Hazard Analysis
Contractor: Location:
1.1.3 Position compressed gas bottle and hoses in a location away from sparks
and flames.
1.1.7 Stop all burning operations 60 minutes before end of shift and review
area for smoldering embers before leaving area.
1.1.8 All grinders will be equipped with wheel guards to control sparks.
1.2 Burns to body parts 1.2.1 Natural fiber or fire retardant clothing should be worn.
(cotton, wool, leather)
1.3 Cuts and abrasions 1.3.1 All grinders will be fitted with guard per manufacturer’s recommendations.
1.4.2 Inspect grinding wheel for possible cracks, breaks and fractures; replace
if necessary
1.4.3 Bring grinding wheel to full RPM slowly while holding grinder in a position
away from body.
1.4.6 Wear a face shield while grinding or have welding hood down with safety
glasses so that the visor can be up.
1.5 Leaking glass 1.5.1 Store all tanks with a protective cap installed and valves closed.
1.5.3 Protect hoses from vehicular traffic and potential impact from foreign
objects.
1.5.4 Inspect all hoses prior to start of work; use only hoses in good repair and
those designed for specific purpose intended.
1.6 Oil on oxygen tank or fittings 1.6.1 Oxygen cylinders, cylinder valves, couplings, regulators, hose and
apparatus should be kept free from and away from oil and gases.
1.6.2 Store torches, hoses and tanks away from potentially hazardous oil.
1.7 Explosion when igniting torch 1.7.1 Use only approved spark lighters (never use a butane lighter)
1.8 Damage to and from compressed gas 1.8.1 Always store cylinder in the full upright position, with protective caps
cylinders installed, and secured to prevent falling, tipping or dislodging.
1.8.3 All empty cylinders must be stored with valve closed to prevent moisture
accumulation in cylinder.
1.8.4 Transporting of cylinders shall only be done with valves closed and
protective caps securely in place.
1.8.7 Monitor all cylinders for damage and report damage to suppliers.
2. Welding 2.1 Fires 2.1.1 Remove all flammable/combustible materials from the immediate area.
2.1.4 Use fire retardant blankets when possible to control sparks and slag.
2.1.5 Stop all welding 60 minutes before end of shift and review area for
smoldering embers before leaving area.
2.2 Electric shock 2.2.1 Assured grounding plan shall be in place and all equipment tested and
marked per plan.
2.2.2 Perform daily inspection of all equipment prior to start of work: any
equipment found in disrepair will be immediately taken out of service.
2.2.3 Do not weld while standing in water, or if clothing and/or gloves are wet.
Wear rubber gloves under leather gloves on wet days.
2.3 Explosions 2.3.1 Disposable butane pocket lighters are not allowed around any “hot work”
2.3.2 Do not weld or use arc gouging equipment whenever the smell of
propane, acetylene or any other fuel or gas is present; determine cause
and correct.
2.4.3 Wear high top boots to prevent slag from falling on shoes.
2.5 Arc radiation burns 2.5.1 Wear protective clothing to cover all exposed skin.
2.5.2 Wear only approved eye protection designed for the work being
performed.
2.6 Inhalation of toxic fumes 2.6.1 Provide and utilize appropriate respiratory protection as necessary.
2.7 Falls 2.7.1 Refer to fall protection work plan for all fall hazards 6’ or greater.
2.8 Material in eye 2.8.1 Wear safety glasses under welding hold. Do not remove slag without
protecting eyes.
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Unload and stage cabinets in work area 1 Strains from lifting 1 Use proper lifting procedures. Use carts to transfer
materials when possible.
2 Place upper and lower cabinets 2 Potential for upper cabinet to fall without 2 Make sure installer has adequate help when
proper support installing upper cabinets. Install all mounting screws
while additional help is available.
3 Install counter tops 3 Use of saw while fitting tops to lower cabinet 3 Make sure all guards are in place prior to operating
saw. Make sure gloves are used during process.
Have material properly supported during cutting.
4 Ladder use while installing cabinets 4 Falls 4 Make sure ladder is positioned properly to avoid over
reaching.
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Same as job posting
Foreman: Doug Dudley General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Install 1x2 blocking 1 Fall off ladder 1 Keep ladder fully open and stable
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Service level exit into loading dock – meet in front of Superintendent: Craig Fader
Building 1
Foreman: General Foreman:
Emergency Numbers
Emergency Phone: 555-618-4229 Crew Members: Robert Hight
Emergency Radio: 154*21*59213
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Set perimeter 1 Falling from edge 1 Safety ropes
2 Install cap sheet 2 Watch for knife cuts 2 Wear gloves
3 Torch cap sheet 3 Being burned 3 Wear gloves and good boots
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Go to office trailer and lock gate Superintendent: Terry Asbury
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Install iso plates 1 Falling from building 1 Safety lines
2 Install base and plates 2 Material falling 2 Stack material securely
3 Weld base sheet 3 Burn from welder 3 Wear gloves and good boots
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Go to office trailer and close gate Superintendent:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Falling material / overhead work
1 Install curtain wall jambs at 30’8’’ elevation 1 1 Barricade area / 100% tie off / post fire watch
Fall hazard / hot work
Fire watch, install red tape at work area and
2 Install curtain wall heads at 20’8’’ elevation 2 Hot works and falls 2
100% tie off
Falling sparks, electric shock Be alert, wear good gloves, tie off, watch before
3 Weld out at curtain wall locations 3 3
Lift dangers and fall going up and down
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Parking lot
Foreman: Kyle Berry General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Gabriel Gonzales Sean Taylor Lyle Avalez
Emergency Radio: Bill Vaughn Dennis Lindgren
Fire: 911 Alex Arroyo
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Punch 1 Fall 1 Life line
2 Glaze #1 2 Fall / cut 2 Life line / gloves
3 Glaze rec 3 Cut 3 Gloves
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Bill Browder
Stairs / parking
Foreman: Ignasso Silva General Foreman:
Emergency Numbers
Emergency Phone: 555-456-4857 Crew Members:
Emergency Radio: 7
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Drill/tap holes in top of frame for hardware 1 Hot metal shavings cause burns to skin and 1 Use arm protection, button shirt completely so
will cause severe eye injuries shavings don’t burn upper body, use eye protection
with side shields. Full face shield will work best.
Position body to the side of work as much as
possible.
2 Using electric drill / tools 2 Electric shock 2 Ensure that GFIC boxes are used and that they have
been tested (push the test button several times).
Inspect cords for damage and/or missing ground pins
3 Using forklift to bring doors from trailer to the 3 Untrained operator, uneven terrain and load 3 Ensure that our operator has been trained on this
building shifting specific type of forklift. Complete our daily forklift
inspection. We will secure the load with a ratchet
strap and we will have a designated spotter to keep
other employees safe.
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Follow Skanska’s plan that is posted throughout the Superintendent:
site. The trailer compound is the meeting and
headcount area Foreman: Albert W. General Foreman:
Emergency Numbers
Emergency Phone: 404-xxx-xxxx Crew Members:
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Prime walls 1 Trip hazard with bucket 1 Keep paint bucket close to wall out of foot traffic
Lock wheels on painters scaffold. Do not walk
2 Cut in 2 Working off of scaffolding/falls 2
scaffold while painting.
Use eye protection during all phases to keep paint
3 Finish paint 3 Paint splatters getting into eyes 3
out of eyes.
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _Proper scaffold use_____________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Same as job posting
Foreman: Danny Trim General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Marek Interior Systems Job Name: Blue Cross Blue Shield
Foreman Name: Martin Martinez Task Description: Interior Build Out
Date: 3/16/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Shoot track 1 Hearing and eye hazard 1 Wear face shield, safety glasses, ear plugs
2 Hand drywall 2 Back strains 2 Stretch and flex exercise
3 Cutting studs 3 Eye, hand, hearing 3 Gloves worn, proper lifting procedure
4 Clean up of building area 4 Hand and back strains 4 Gloves worn, proper lifting procedure
5 Frame exterior (boomwork) 5 Fall hazard!! 5 Must wear safety harness and tie off!
6 Finishing columns 6 Glass crates 6 Have crates moved
7 Installing grid and tile 7 Holes in access floor 7 Schedule work away from cones or perimeters
8 No eating, drinking, smoking or using
bathrooms in buidling
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Nearest safe exit from building Superintendent: Will Perkins
Meet at Marek container box
Foreman: Martin Martinez General Foreman:
Emergency Numbers
Emergency Phone: 411 Crew Members:
Emergency Radio: Channel 1
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Marek Brothers Job Name: Music Building
Foreman Name: Pablo Lucio Task Description: Interior framing, insulation and sheetrock
Date: 4/1/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Metal stud framing 1 Shard edges 1 Gloves
2 Shop saw cutting stud 2 Metal dust and loud noise 2 Face shield and ear plugs
3 Hilti 120 pinning down track 3 Loud noise 3 Ear plugs
4 Wood blocking at stairs 4 Wood dust 4 Face mask
5 Scissor lift 5 Right area 5 Careful
6 Insulation 6 Fly glass 6 Face mask
7 Clean up 7 Stud and sheetrock 7 Trash dumpster
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
gate
Foreman: Pablo Lucio General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire:
Other: Call your safety person Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Schnurr Inc. Job Name: St. Davids 2nd Floor Renovation
Foreman Name: Mike Hennigar Task Description: Tape and Float Temporary Walls
Date: 4/3/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Tape and Float 2 Slip, trip, fall from wet mud 1 Use drop cloth, clean up immediately
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
atrium
Foreman: Mike Hennigar General Foreman:
Emergency Numbers
Emergency Phone: 555-797-0195 Crew Members:
Emergency Radio:
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Marek Bros Systems Job Name: St. David Renovation
Foreman Name: Ed Cheney Task Description: Upgrade patient rooms (Install Trim)
Date: 4/3/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Use powder activated fasteners and
1 Install metal stud framing 1 1 Safety glasses, gloves
screwgun
2 Clean work area daily 2 Trash creates tripping hazard 2 Clean work area
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Exit down to first floor atrium Superintendent: Ed Cheney
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Marek Bros Systems Job Name: St. David Renovation
Foreman Name: Ed Cheney Task Description: Install temporary partitions / install metal framing / install sheetrock
Date: 4/6/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Install plastic barrier 1 Lift out tile in ceilings. Use ladder 1 Be alert as to potential above ceiling hazards
Wear gloves handing sharp material, use ladder in
2 Metal top track 2 Metal track has sharp edges, use 35’ ladder 2
proper manner
3 Install and erect metal studs 3 Studs have sharp edges 3 Use proper PPE
4 Shoot down metal track 4 Sharp edges 4 Use proper PPE
5 Install sheetrock 5 Heavy material, screwgun 5 Handle material in proper manner
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Exit down to first floor atrium Superintendent: Ed Cheney
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Jake Marshall LLC Job Name:
Foreman Name: Randy Long Task Description: Plumbing – finished painting rupture disc for piping. Grouted CHW
Date: Pump VFD Stands. Labeled RTU’s piping and finish all valve tagging
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Housekeeping and general work 1 Slips/trips/falls 1 Keep area clean/organize stay alert
Proper PPE/ extra caution when cutting and handling
2 Material handling 2 Cuts/abrasions/misuse 2
material
Proper use of ladder/ tie off if needed/ no standing
3 Ladder use 3 Falls 3
about the second rung
4 Mechanical joining 4 Cuts/burns/pinches 4 PPE/ stay alert/ MSDS
5 Soldering copper 5 burns 5 PPE/ Hot work permit and fire extinguisher nearby
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
1- Bldg. – roundabout Skanska Superintendent:
Total complex – brick building
Foreman: Randy Long General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Jeff Trehern John Perry Danny Alvarez
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Marek Job Name: Office Remodel
Foreman Name: Rick Jecker Task Description: Frame acoustical ceilings
Date: 3/26/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Shoot hanger wires 1 Using powder actuated guns 1 Ensure user has certification and wearing proper
PPE including hearing protection. Take caution that
no unspent rounds are left on floor.
2 Install wall mold 2 Use stilts installing trim. Use of laser level 2 Check equipment and ensure that workers have
been trained on the proper use of stilts. Check entire
work area for trip hazards. Have safe area for
mounting and demounting of stilts.
3 Frame grid 3 Scaffold and stilts use 3 Make sure perry scaffolds are inspected. No walking
of scaffolds. Use of guard rails over 6’
4 Laser level 4 Eye exposure 4 Use of proper postings of laser use in area. Proper
eye protection. Keep nonessential workers out of
area.
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: warning signs for laser use that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Same as jobsite designation
Foreman: Rick Jecker General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: MSI Job Name: CSU
Foreman Name: Travis Spurling Task Description: Metal Stud and Drywall
Date: 4/22/08
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Metal panel delivery 1 Fork lift safety 1 Pay attention to slopes and grades
2 Install substrate for metal panel installation 2 Boom lift safety, material handling 2 Harness and lanyard tie off, pay attention to others
3 East and west exterior of C bldg frames 3 Boom lift safety, coworkers below 3 Pay attention to others, harness and lanyard tie off
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Travis Spruling
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 9 - Finishes
Job Hazard Analysis
Construction Phase: Painting Project:
Contractor: Location:
1.2 Injection wounds 1.2.1 In case of injection wound, seek immediate medical attention.
2. Set up spray rigs 2.1 Back injury and electrical shock 2.1.1 Check placement of equipment and ensure power is hooked up correctly
before power is turned on.
3. Spray painting 3.1 Breathing in of mist and over-spray 3.1.1 Follow manufacturer’s directions. Use respirators if levels are above
Breathing in of vapors PEL’s (indoors particularly)
3.1.2 Review MSDS sheets for each paint product that will be used in occupied
space. Use proper ventilation at all times.
3.4 Damage to property; damage to other 3.4.1 Protect all areas from paint over-spray. Never let painters work over
trades finished products exposed finishes.
3.4.2 Assess all site conditions when applying exterior paints. Look for items
that wind-blown over-spray might reach and protect these items if there is
even a remote change for damage.
4. Other trades working 4.1 Danger of foreign objects falling from 4.1.1 Use extreme caution when other trades are using lifts, cranes.
overhead above
5. Disposal of hazardous 5.1 Hazards to people and environment 5.1.1 Such materials shall not be deposited in the contractor’s waste
and toxic materials containers.
6. Waste product disposal 6.1 Fire and/or adverse personal or 6.1.1 Keep used flammable liquids and/or gas rags in approved containers until
environmental exposure removed from the job.
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Colgando tubería de 1 ½” en el area abierta 1 Riesgo a caerse y pegarle a un compañero 1 Asegurarlas bien a trabajar con cuidado
2 Usando la maquina de hacer rosca 2 Peligro a quemarnos o dañarnos los ojos 2 Usar guantes y lentes de seguridad
Usarla apropiadamente y no usa los dos ultimos
3 Usando excabras de 8’ 3 Peligro a caernos 3
escalones
4 Usando las llaves para apretar la tubería 4 Riesgo a caerse y pegarle a un compañero 4 Trabajar con seguridad y mirar alrededor
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Parking lot
Foreman: Israel lopez General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Abel Moncado
Emergency Radio:
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Lay pipe out 1 Tripping hazard 1 Lay pipe out of the way
2 Cut fods 2 Cutting fingers 2 Cut rods on tripod
3 Hang pipe 3 Falling 3 Tie off
4 Pull in pipe
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Lock out system 1 Opening pressurized lines 1 Lock out / tag out and depressurize lines
2 Repair air line 2 Electrical shock 2 Use of GFCI on all outlets
3 Cuts and bruises 3 Proper PPE
4 Fall 4 100% tie off over 6 feet
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Don Reed
Skanska trailer
Foreman: Mike Welch General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Jake McCall
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Gerald & Sons Job Name: Clayton State University
Foreman Name: Bob Byrne Task Description: Overhead Gas & Steam
Date: 3/30/08 Overhead storm drains, water lines and in-wall sanitation
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Use of lifts and ladders 1 Falls, trips. Caught in between 1 Competent person on lift
2 Compressed gas 2 Burn, fire, explosio 2 Check equipment daily
3 Electrical equipment 3 Caught in equipment 3 Check all cords and tools
4 Electrical cord/ tools 4 Shock 4 Full body harness
5 Power tools 5 Flying objects 5 Full face mask
6 Hand tools 6 Body injury 6 PPE
7 Lifting material
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Bob Byrne
Exit to parking lot
Foreman: General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Kris Elder Jack Smith David Clark
Emergency Radio: Landon Anderson Stovall Lee
Other: Skanska only Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Job Name: BCBS
Foreman Name: Jack Savage Task Description: HVAC Commissioning
Date: 3/11/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 HVAC system conveyance 1 Low voltage electrical 1 Good work practice
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
various
Foreman: Jack Savage General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Jake Marshall LLC Job Name: BCBS
Foreman Name: Task Description: Plumbing
Date: 3/12/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 House keeping and general 1 Slips/ trips/ falls 1 Keep area clean/ organize/ stay alert
Proper PPE/ extra caution when cutting and handling
2 Material handling 2 Cuts/ abrasions/ misuse 2
material
Proper use of ladder/ tie off if needed/ no standing
3 Ladder use 3 Falls 3
above the second rung
4 Mechanical joining 4 Cuts/ burns/ pinches 4 PPE/ stay alert/ MSDS
5 Soldering copper 5 Burns 5 PPE/ Hot work permit/ fire extinguisher nearby
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Breeding Insulation Job Name: BCBS Cameron Hill Project
Foreman Name: Eddie Weigart Task Description: Insulation work on HVAC Ductwork / Piping /Plumbing
Date: 3/12/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Emphasis on awareness of surroundings
1 General clean-up and housekeeping 1 Tripping hazards and slips 1
Emphasis on keeping work areas clean
Proper material handling
2 Distribution and handling of job materials 2 Potential for cuts, scrapes and miss-handling 2
Appropriate PPE
Proper use of ladders/ scaffolding/ lifts
3 Elevated work from ladders and man lifts 3 Potential for falls 3
Tie off for elevated work
4 Cutting and application of insulation 4 Potential for eye and hand injuries 4 Appropriate PPE/ gloves
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Chad Weigart
Other: Site contact mobile – 421-2610 Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Jake Marshall LLC Job Name:
Foreman Name: Task Description: HVAC
Date: 3/11/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Housekeeping and general work 1 Slips/ trips/ falls 1 Keep area clean /organize/ stay alert
Proper PPE/ extra caution when cutting and handling
2 Material handling 2 Cuts/abrasions/miss use 2
material
Proper use of ladder/ tie off needed/ no standing
3 Ladder use 3 Falls 3
above the second rung
4 Mechanical joining 4 Cuts/ burns/ pinches 4 PPE/ stay alert/ MSDS
5 Duct/ hanging/ fastening 5 Eye/back/hand injuries 5 PPE/ Proper lifting technique / use all guards
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
P-lot in front of B-1 Superintendent:
“Fire Hall” p-lot
Foreman: Tommy General Foreman:
Emergency Numbers
Emergency Phone: 555-266-2753 Crew Members: Juan Vann Jason Hodge Bobby Kitchings
Emergency Radio: Joe Stoneifer Eugene Garth
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: McAllen Sheet Metal Job Name: UTB – TSC Music Building
Foreman Name: Mike Garcia Task Description: Installation of duct work systems
Date: 3/30/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Utilize scissor lift for installation of duct work Check batteries for waterlevel – cable Check electrical cords. Wear safety glasses and
1 1 1
systems terminals tight and clean gloves.
Falls, trips, cuts. Metal shavings or dust in Keep platform clean, wear gloves, safety glasses,
2 Install duct supports – unistrut or straps 2 2
eyes. Loud noise. Drop materials. face shield, ear plugs. Tie-off. Flag off area
Keep platform clean. Wear gloves and safety
Falls, trips, cuts. Metal shavings in eyes.
3 Install overhead duct work 3 3 glasses. Lift with legs. Keep arms close to body.
Back strains.
Flag off area.
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Exit west side of building Superintendent: Mike Garcia
Meet at front gate
Foreman: Cesar Santino General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Sergio Arce Rafael Garcia
Emergency Radio: Joe Limon Jose Gustar
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: CTO Job Name: Music BLDG
Foreman Name: Abel Flores Task Description: Install water lines
Date: 4/1/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Weld support brackets for fitting ends 1 Fire may start while welding 1 Fire extinguisher
3 Test 8” line on south side 3 Water leak may burst 3 Caution off area below and let them know
4 Clean and secure areas 4 Watch machinery and lifts 4 Be aware of surroundings and proper PPE
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Main gate
Foreman: Jose Abel Flores General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Dan Jones Frank Brooks Jr.
Emergency Radio: Donald Preston Mario Villarreal
Fire: Ruben Hernandez Ricky Alvarez
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: DSI Job Name: 2nd Floor Renovation SDMC
Foreman Name: Jody Gothard Task Description: Demo plumbing fixtures for wall demo
Date: 4/8/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Remove lavatory 1 Water, debris, infectious 1 Buckets, towels, PPE, Hepatitis B shot
2 Remove commode 2 Water, debris, infectious 2 Buckets, towels, PPE, Hepatitis B shot
3 Remove shower drain 3 None 3
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Anti-room Superintendent: Bill Taylor 555-848-1411
Exit of construction site
Foreman: Judy Gothard General Foreman:
Emergency Numbers
Emergency Phone: 555-748-0690 Crew Members: Abel Baldenegro Tomas Garces
Emergency Radio: 142*25*31537
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Mock Job Name: GMC New Preparatory School
Foreman Name: Martin Hicks Task Description: Installing Pipe
Date: 5/13/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Trenching, excavating 1 Ditch caving in, hit by machine 1 Step back ditch
2 Carrying materials 2 Carrying heavy loads 2 Get help with heavy loads
4 Cover up, compaction 4 Tamping foot, hit by boom 4 Wear toe guards, be aware of surroundings
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Front job trailer
Foreman: Martin Hicks General Foreman: Tim Brown
Emergency Numbers
Emergency Phone: Crew Members: Jimmy Drake Timothy Coates
Emergency Radio: Keith Hicks
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Allied Mechanical Service Job Name: BCCHS
Foreman Name: Don Reed Task Description: Pipe Installation
Date: 5/5/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Set anchors with power tools 1 Shock 1 Use of GFCI, inspection of tools prior to use
Install hangers/supports with hand tools - 2 Falling from heights, cuts, abrasions and blunt 2 Daily inspection of scaffold, ladders and lifts. Be
2 sometimes at heights above 6’ blows to limbs aware of hand and tool placement. Understand the
tools purpose. Proper tool for the job.
3 Install pipe with some rigging 3 Load may fall, pinch points 3 We are trained in proper rigging. Be aware of the
surroundings.
4 Some soldering 4 Burns 4 Wear proper PPE including gloves.
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No **See jobsite trailer
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Don Reed
Skanska’s jobsite trailer
Foreman: Jack Wilk General Foreman: Frank Estes
Emergency Numbers
Emergency Phone: 911 Crew Members: Rob Whitley George Bluth Ken Smith
Emergency Radio: 911 Scott Seaver Charlie Brooks Rob Ephron
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Allied Mechanical Services Job Name: BCCHS
Foreman Name: Don Reed Task Description: Remove roof top heating units off old auto shop
Date: 5/5/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Access roof 1 Falls 1 Use of man lift instead of ladder
st
1 man on roof ties off 2 retractables and gives the
2 Working on roof 2 Falling off roof 2
2nd line to fellow worker (100% tie off)
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Don Reed
Skanska trailer
Foreman: Mike Walker General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Jim Woodall Brian Wiseman
Emergency Radio: Scott Hatch
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Allied Mechanical Service Job Name: BCCHS
Foreman Name: Don Reed Task Description: Underground Piping
Date: 5/6/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Digging / trenching / excavating 1 Possible underground obstructions 1 Follow SHMP req. (pg 23)
Falling into trench Use caution tape around unattended trenches
Struck by moving excavation equipment Be aware of where equipment is
Trench access If more than 4 feet use a ladder
2 Install, prim and glue piping 2 Primer and/or glue in eyes 2 Proper PPE
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No **See jobsite trailer
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Don Reed
Skanska jobsite trailer
Foreman: General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Richard Martinez
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Allied Mechanical Services Job Name: Battle Creek Central High School
Foreman Name: Dave Stewart Task Description: Underground Piping
Date:
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Digging / trenching / excavating 1a Possible underground obstructions 1a Follow SHMP requirements for excavation (pg 23)
1b Falling into trench 1b Use of caution tape around unattended trench (s)
Be aware of where equipment is and wear high
1c Struck by moving excavation equipment 1c
visible vests
Use ladders to get in and out of trenches if more than
1d Entering and exiting of the trench 1d
4 feet
2 Install prime and glue piping 2 Primer and/or glue in the eyes 2 Proper PPE (safety glasses)
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No *See foreman for MSDS’s
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Division 15 - Mechanical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Fitzgerald & Sons Job Name: Clayton State
Foreman Name: Bob Byrne Task Description: Overheard Gas
Date: 5/15/08
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Scaffolding, lifts and ladders 1 Falls, trips, slips 1 Proper use/ secured
2 Electrical tools & cords 2 Electric Shock, trips 2 Cords off floor & check for ground prongs
3 Compressed gas 3 Fires, burns, explosion 3 Proper use & NO open flames
4 Hand tools 4 Flying objects, debris 4 Proper use & not damaged
5 Gas powered tools 5 Fires, bodily harm 5 Proper use and maintanence
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Bob Byrne
Exit to parking lots
Foreman: General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Kris Elder
Emergency Radio: David Clark
Other: Skanska thru only Use the Back of this Form to List Any Additional Steps and Other Information
Division 15 - Mechanical
Pre-Task Plan Playbook
Table of Contents
Division 1 - General Requirements
Division 2 - Site Construction
Division 3 - Concrete
Division 4 - Masonry
Division 5 - Metals
Division 6 - Wood and Plastics
Division 7 - Thermal and Moisture Protection
Division 8 - Doors and Windows
Division 9 - Finishes
Division 10 - Specialties
Division 11 - Equipment
Division 12 - Furnishings
Division 13 - Special Construction
Division 14 - Conveying Systems
Division 15 - Mechanical
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: ACC Electric Job Name:
Foreman Name: Rocky Moore Task Description: Finish up slab cut in, clean and straighten up, thread pipe
Date: 4/20/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Dig with shovel 1 Blisters on hands 1 Use gloves
2 Install conduit 2 Glue, cutting hand 2 Gloves and PPE
3 Back fill and tamp 3 Smashing toes 3 Strap on steel toe
4 Set up equipment 4 Smashing finger 4 Gloves
Cutting yourself Gloves and PPE
5 Cut pipe 5 5
Metal shavings Glasses, hard hat
6 Thread pipe 6 Through you 6 Use plenty of threading oil, use long brace
7 Ream pipe 7 Cutting hand 7 Wear gloves
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No Glue, cutting oil
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Meet at trailer
Foreman: Rocky Moore General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Kirk Morris Jay Mettler
Emergency Radio: Keith Hubbard Ted Kuhl
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: LMI Electric Job Name:
Foreman Name: Chuck Groves Task Description: Wall rough in
Date: 3/26/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
Possible cuts of scrapes on wall framing Use gloves while pulling MC cable through stud cut
1 Mount boxes in wall 1 1
material outs
Extend EMT unto plenum from low voltage Keep work area clear of cut off pieces of conduit and
3 3 Trip hazards from pieces of conduit 3
outlets cabling
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: Training on proper use of ladders that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Same as job posting
Foreman: Chuck Groves General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire: 911
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Global Electric Job Name: Music Building
Foreman Name: Jose Salazar Task Description: Rough In
Date: 4/1/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Running AC cable 1 Sharp metal stud and pipe 1 Use gloves and work safe all the time
2 Running EMT pipe and set some boxes 2 Sharp metal stud and pipe 2 Use gloves and work safe all the time
for audio
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Jose Salazar
Parking lot
Foreman: General Foreman: Juan Andrede
Emergency Numbers
Emergency Phone: 911 Crew Members: Jose R. Hoez Domingo Perina
Emergency Radio: Luis Florez Cl. Blanc
Fire: 911 Jimmy Galvan
Other: 911 Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Parker Electric Job Name: St. David’s Second Floor Remodel
Foreman Name: Jon Jensen Task Description: Install Conduit and Demo Lighting
Date: 4/8/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Hammer drill for conduit run 1 Ladder falls, tool slips, dust 1 Ladder safety, care when using tools, Normal PPE
2 Install conduit 2 Ladder falls, tool slips, overhead obstacles 2 Ladder safety, care when using tools
Be aware of surroundings
3 Demo lighting 3 Tool slips, shock 3 Care when using tools, identify circuits and
Lockout/tagout where possible
Use care around live circuits
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Stairs to atrium
Foreman: Jon Jensen General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Matt Hubel Joe D. Eckert Clint Hughes
Emergency Radio:
Fire: 233-9391
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: J Reynolds Job Name: EHRMC
Foreman Name: Martin Gonzales Task Description: Unload trucks, Remove Ballast
Date: 4/9/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Remove ballast 1 Falling, dropping dust 1 100% fall protection within 8’ of fall hazards
Block off egress routes of pedestrians
PPE
While removing ballast, ensure filters in place and
clean at intakes
2 Unload materials 2 Fork lift, falling, cuts 2 100% fall protection for roof personnel at edge
PPE including gloves for handlers
Provide flaggers for trucks and lift
Be aware of surroundings
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Martin Gonzales
Loading dock
Foreman: Randy Pitre General Foreman:
Emergency Numbers
Emergency Phone: 555-877-8375 Crew Members:
Emergency Radio:
Fire: 911
Other: 911 Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Vela’s Electric Job Name: La Joya High School
Foreman Name: Martin Maydon Task Description: Electrical Rough-In
Date: 4/8/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Wiring building 1 Fall, slip, trip 1 Good work practices
5 Temporary lights
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent: Eloy Vela
Bentson Road
Foreman: Martin Maydon General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Toby Garcia Juan Campos Baldermar Perrett
Emergency Radio: Joe Silva Miro Vela
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Parker Electric Job Name: St. David’s 2nd Floor Remodel (Phase 4)
Foreman Name: Jon Jensen Task Description: Demo Power and Lighting
Date: 4/7/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Locate power to be removed 1 Ladder falls, debris on floor 1 Ladder safe, be aware of surroundings
2 Determine if power can removed 2 Ladder falls, shock, debris on floor 2 Ladder safety, use meter, be aware of surroundings
Ladder safety, be aware of surroundings –
3 Remove conduit to J-Box 3 Ladder falls, debris on floor, fire sprinklers 3
both above and below
4 Cut hole in panel 2HEDP4 sec. 2 4 Shock hazards 4 Use caution around live ports
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
nd
Stairs to 32 street parking lot Superintendent:
Meet at atrium
Foreman: Jon Jensen General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Jack Eckert Clint Hughes Max Heard
Emergency Radio:
Fire:
Other: 828-9961 Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Parker Electric Job Name: St. David’s 2nd Floor Renovation
Foreman Name: Jon Jensen Task Description: Electrical Demo
Date: 4/3/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Ladder climbing 1 Overhead projections 1 Check equipment for defaults
2 Overhead ceiling work 2 Electrical exposed 2 Wear hard hats and safety glasses
3 Testing ckts and demo of power 3 Loose overhead equipment and systems 3 Use electrical equipment to check ckts
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
patio
Foreman: Jon Jensen General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members:
Emergency Radio:
Fire:
Other: Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Parker Electric Job Name: St. David’s 2nd
Foreman Name: Jon Jensen Task Description: Demo
Date: 4/6/09
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Demo 1 Above ceiling Hard hat
Raise lights to deck All thread Safety glasses
Work boots
2 Demo recpt’s where possible 2 Abandoned wires Elec. EQ – meters
Sharp objects Circuit tracers
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
Patio
Foreman: Jon Jensen General Foreman:
Emergency Numbers
Emergency Phone: 911 Crew Members: Jeremy Drexel
Emergency Radio:
Other: 828-9961 Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical
Appendix F: Daily Pre-Task Safety Plan
Subcontractor: Miller Electric Job Name: Clayton State College
Foreman Name: Harry Haidt Task Description: Pull MSB Feeders to 750kva transformer outside
Date: 5/30/08
List All the Steps of the Job (Use additional paper if needed) Identify All Specific Hazards Found How Will You Control the Hazards?
1 Uncover main switch board 1 Eyes 1 PPE
2 Secure wire puller 2 Hands, eyes 2 PPE
3 Pull in wire pulling rope 3 Head, hands 3 PPE
4 Set up wire on jacks 4 Feet slip 4 Good work practices
5 Serve wire to rope 5 Hands 5 PPE
6 Pull wire to MSB 6 Hands 6 PPE
7 Breakdown tugger and put away 7 Hands, feet trip 7 PPE, Eliminate
Use the Back of this Form to List Any Additional Steps and Other Information
Hazard Identification Tips Hazard Evaluation Tips Hazard Control Tips
What permits are required for this task? Use the following categories to assist you in determining the proper control methods for all the
Confined Space Hot Work Lockout/Tagout Use the following categories to assist you in a proper evaluation of all the hazards hazards that have been identified and evaluated.
Other: _________________________________________________ that have been identified. Can any of the following conditions occur with the hazards Ventilation of exposure area Change of work methods
Will the removal of an existing guardrail or means of fall protection be required for this that have been identified? Isolation of hazard from worker Good work practices
work? Substitution of hazard with less severe one Personal protective equipment
Yes No Contacting Temperature Extremes Struck By Elimination of hazard Other
Contacting Electrical Current Struck Against
Is there a potential fire, explosion, toxic or radioactive release hazard? Environmental/Airborne Release Fall/Slip/Trip
Yes No Moving Object/Equipment Caught In/Between
Housekeeping
Are there any MSDSs that might need reviewed for hazardous substances that might Hazardous Substance Material Handling
Obstruction/Interference Other Was site cleaned up and secured after work?
be present on the job site?
YES NO
Yes No
Evacuation Route Signatures
What is your evacuation route and assembly point?
Superintendent:
trailer
Foreman: Harry Haidt General Foreman: Mark Rocker
Emergency Numbers
Emergency Phone: Crew Members: J.E. Wheeler Robert Bell Andy Kukley
Emergency Radio: H.G. Casey Jerry Klein
Fire: Ronnie Padgett Jerome Edwards
Other: Ricky Clayton Use the Back of this Form to List Any Additional Steps and Other Information
Division 16 - Electrical