Performance Insulation Contractors, Inc. Job Safety Analysis by qjk18715


									Performance Insulation Contractors, Inc.
Job Safety Analysis
Task:                                                                   Date:
Permit / Work Order #:                                            Crew Size:
Evacuation Route:                                                Supervisor:
Location of Shower & Eyewash:                                   Plant Name:
Wind Direction:                                                   City, State:

                   Personal Protective
 Y      N   NA         Equipment         Y   N   NA           Lifting             Y    N   NA           Access
                  Gloves/Leather                      Forklift                                  Scaffold Inspected
                  Gloves/Other                        Cherry Picker                             Ladder (Tied Off)
                  Hearing Protection                  Crane                                     Manlift
                  Safety Glasses                      Carry Deck                                Spider
                  Safety Goggles                      Chainfall                                 Special Provision
                  Hazard Resistant                    Proper Rigging                            Scissor Lift
                  Clothing                            Manual Lifting                            JLG Style Lift
                  Rubber Boots                        Equipment Conditon                        Other
                  Fall Protection                     Other
                  Other                                                                         Units Specific Training
                                                              Permits                           Known Potential Hazards
                          General                     Required?
                       Requirements                   See Work Order                              Hazards (Chemical)
                  Post Warning Signs                  Hazard Work Permit                        Chem Burns - Eyes
                  Relocate Flammables                 Entry Permit                              Chem Burns - Skin
                  Barricades                          Confined Space                            Chem Burns - Lungs
                  Ventilation/Exhaust                 Hole Watch                                Eye Protection Areas
                                                      Sign Off When Job                         Ingestion
                        Specialized                   is Completed                              Inhalation
                         Operations                   Other                                     Skin Contamination
                  Lock Out / Tag Out                                                            Benzene
                  Line Breaking                       Hazard Communication
                  Confined Space Entry                Health Hazards                                 Hazards (Body)
                  Evacuations                         Physical Hazards                          Fall Potential
                  Shoring                             MSDS Available?                           Pinch Points
                  Hot Tap                                                                       Slip/Trip/Fall Potential
                  Scaffolding                            Hazards (Environ.)                     Cuts
                  Abestos Abatement                   Airborne Articulates
                  Working Energized                   Electrical Shock                              Housekeeping
                  Electrical Circuit                  Heat Stress                               Walkways
                  Crane Suspended                     Heavy Objects                             Work Area
                  Work Platform                       Hot/Cold Surfaces                         Tools Stored Properly
                  Other - Notify Mgmt                 Restricted Lighting                       Materials Stored
                  for Procedures                      Noise                                     Equipment Stored
                                                      Sharp Objects                             Trash/Scrap Disposal
                           Tools                      Access/Egress
                  Proper Tools                        Sharp Objects              Other Safety or Special Concerns:
                  Current Inspection                  Moving Equipment
                  Good Tool Condition                 Elevated Work Area
                  Qualifications                      Steam

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