Sample Task Planning Worksheet
TASK PLANNING WORKSHEET
Company: Foreman: Type of Work: Personal Protective Equipment Required (PPE) ?? O
YES NO SPECIFIC COMMENTS
Date: Work Location: Crew Size:
Barricades / Signage Face Shield Fall Protection Flash Shield Gloves Goggles Hearing Protection Respirator Safety Glasses Special Clothing Ventilation
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Work Permits & Additional Safety Plans ??
YES NO
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If “YES” contact ABC Supervision
SPECIFIC COMMENTS
CIPP Confined Space Competent Person Demolition / Sawcutting Energized Electrical Excavation Permit Hot Work Permit Lockout / Tagout
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Loading Structural Slab ρ Need Detailed Safety Plan ρ
Possible Impact ??
If yes, call KEN HETTINGER (ABC) 460-4978 Before Starting
E
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Sample Task Planning Worksheet
YES NO WHAT / WHERE
Airfield Operations Airlines / Tenants Environmental Life Safety Systems Public Traffic Security
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TASK CHECKLIST. Must be reviewed with all crew members for their input.
1) a) WORK AREA. A
YES NO SPECIFIC COMMENTS
Are you familiar with the work area?
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b) Have you identified the hazards? c) Are plans in place to manage the hazards?
d) Are there critical systems in the area? e) f) 2) a) Will you work near live systems? Are lockout of systems required? YOUR TOOLS & EQUIPMENT Are your electrical tools checked & tested?
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b) Do you have the work materials you need? c) Do you have the safety equipment you need?
3) MATERIAL HANDLING a) Is adequate help or equipment available for lifting? ρ ρ Is there safe access to materials? Don’t overstock! ρ Y ρ ρ ρ ρ ρ ρ ρ ρ ρ
b) Has a proper storage area been determined? c)
4) PEOPLE a)
Is each worker properly trained?
b) Is the crew aware of the work sequence? c) Are you coordinated with other crafts?
THIS TASK PLAN WAS REVIEWED WITH ALL CREW MEMBERS AT THE WORK AREA. EVERY MEMBER HAS HAD INPUT. J
CREW SIGNATURES
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Sample Task Planning Worksheet
WHAT SAFETY EQUIPMENT OR MATERIALS DO YOU NEED TO ORDER?
@
When do you need it delivered on-site? 6
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