SAFETY PRE-TASK ASSIGNMENT PERMITS / OPERATIONAL CONTROL

PROCEDURES REQUIRED: LADDERS/SCAFFOLDS:

The SPA should be completed daily for each task. Post this Yes No 6. Inspect all scaffolds/ladders before use.
SPA in a conspicuous location throughout the length of the Hot Work Permit Has the scaffold tag(s) been signed?  Yes  No
task. Each crew member involved with the task should sign; Excavation Permit
this SPA. At the end of the task, give this SPA to the Does the ladder(s) have current inspections?  Yes  No
Working at Heights Permit
Project/Site Management. If deviation from known safe Confined Space Entry Permit
work practice/ procedure occurs, work must be stopped. Lifting Permit APPLICABLE PERSONNEL:
Supervisor: ______________Date: ________________ Signs/Barricades OCP 7. Is a fire watch/warden/standby man/flagman/rigger required?
Lockout, Tag out OCP  Yes  No
Location of Task: ______________________________ Scaffolds OCP Name: _____________________________________
_____________________________________________ Risk Assessment
Task Description: ______________________________ Tool Box Talk IN CASE OF EMERGENCY:
_____________________________________________ Other (specify) _______________________________
_____________________________________________ 8. Identify below the location of the nearest
EMPLOYEE/EQUIPMENT CERTIFICATIONS - Assembly area________________________________
Does task require specific training?  Yes  No REQUIRED: - Fire Fighting Equipment_________________________
If yes, what type?
Yes No - First Aid Box_________________________________
_____________________________________________ Plant / Equipment (specify) ____________________
HOUSEKEEPING:
PERSONAL PROTECTIVE EQUIPMENT Plant / Equipment Operator (specify) ____________
REQUIRED: Scaffold Insp./Supv/Erector (specify) ____________ 9. Are trash receptacles/bin/containers/drums/boxes etc.
Yes No Type Rigger 1/2/3 (specify) ____________ available in the work area?
Other (specify) _________________ Location: _____________________________________
Head __________
GENERAL
Eyes -- __________ FALL PROTECTION:
INFORMATION
Face __________ 1. Should Safety/Representative be involved in 10. Have areas been identified as requiring fall protection
systems and have they been installed? (i.e., lifelines,
Hearing __________ the planning of this task?  Yes  No
guardrails, barricades, hole/floor & wall opening covers,
2. What are the hazards associated with the task? etc.)  Yes  No
Respirator __________ _______________________________________________ Explain: _______________________________________
Hand __________ _______________________________________________ _______________________________________________
Have they been explained to the employees?  Yes  No
Full body harness __________ FIRE PROTECTION:
Foot __________ 3. What weather conditions could affect the 11. Are flammable/combustible materials stored, separated,
safety performance of this task? inspected and secured per procedure?  Yes  No
Uniform __________ __________________________________
Others (specify) ________________ __________ ASSIGNED EMPLOYEES:
TOOLS & EQUIPMENT:
PPE Examples: Approved Safety Helmet with chin Name Badge #
_______________________ ________________
strap, Safety Glasses (dark/clear), face shield visor, 4. User inspection is required of all tools, ladders, electrical
_______________________ ________________
disposable coverall, welding (goggles, shield, sleeves), cords, rigging and safety equipment
_______________________ ________________
ear plugs & muffs, hand gloves (leather, nitrile or latex Has this been completed?  Yes  No
______________________ ________________
coated, chemical gloves, gauntlets,), Safety shoes, boots MATERIAL STORAGE: _______________________ ________________
(rubber),gumboots, high visibility vest, full body _______________________ ________________
harness (with double/single lanyards) fall protection 5. Has a material storage area been identified and approved? _______________________ ________________
equipment, respirator mask, uniforms, etc.  Yes  No _______________________ ________________
 SUPERVISORS SAFETY PRINCIPLES POST SAFETY TASK REVIEW: NATIONAL CONTRACTING CO.LTD. Doc. Ref. : NCCT&D.S.FRM.063
(TRANSMISSION & DISTRIBUTION DIVISION) Revision: 00
Ver. Date: 15/10/2015
SUPERVISOR: ____________________________________ SAFETY PRE-TASK ASSIGNMENT Effective Date: 01/11/2015

DATE: ___________________________________________
 Plan Every Job
1. Was anyone injured or did an unplanned incident
occur today? If yes, explain.
 Anticipate Unexpected Events Yes _____ No _____
___________________________________________
___________________________________________
 Use Procedures As Tools
2. Was the accident/incident reported to the safety
 Use The Right Tool For The Job department? Yes _____ No _____

3. What problems were encountered with today’s work

 Identify The Hazards assignment?
__________________________________________
_______________________________________
 Eliminate/Substitute Hazards
4. What can be done tomorrow to improve
performance?
 Minimize/Reduce The Hazards __________________________________________
____________________________



Isolate/Separate the Hazards

Administrative/Engineering Control
5. Miscellaneous concerns:
___________________________________________
_____________________________
SAFETY

Measures

Protect the Person

6. Reviewed by:
Supervisor:
Foreman: _______
___ Pre-TASK
 Assess People’s Abilities NAME
ASSIGNED EMPLOYEES:

______________________
______________________
 Monitor & Evaluate Effectively ______________________
______________________
______________________
 Audit These Principles ______________________
______________________
______________________
______________________
______________________
RETURN FORM IN TO PROJECT/SITE ______________________
MANAGEMENT AT END OF SHIFT OR ______________________
WHEN TASK IS COMPLETED. ____________________
BADGE #
_________________
_________________
ASSIGNMENT
_________________
_________________
_________________
_________________
_________________
_________________
_________________
_________________
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