08c-Supbook-STA by jakianur

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									        SAFETY TASK ASSIGNMENT                       Hot Work                                                 Has the the scaffold tag(s) been signed?
                                                     Lock, Tag, Try                                                                     Yes  No
The STA should be completed daily for each task.     Excavation                                               Does the ladder(s) have a current
Post this STA in a conspicuous location              Signs/Barricades                                         inspection?           Yes  No
throughout the length of the task. Each crew         Confined Space                                  
member involved with the task should sign this       Crane Lift                                                      APPLICABLE PERMITS:
STA. At the end of the task, give this STA to the    Line Break/Hot Tapping                               7. Is a fire watch or vessel attendant required?
Project/Site Management. If deviation from           Scaffolds                                                                          Yes  No
known safe work practice/ procedure occurs,          Other (specify)                                         Name: ______________________________
work must be stopped.
                                                             EMPLOYEE CERTIFICATIONS                                 EMERGENCY EQUIPMENT:
Supervisor: ______________Date: ______                             REQUIRED:                                8. Identify below the location of the nearest
Location of Task: _____________________                                                    Yes     No          safety shower and alarm box. ___________
___________________________________                  Crane Operator                                          ___________________________________
_______________________________________              Forklift Operator                                       Alarm Box #            ____________
_______________________________                      Mobile Equipment Operator                       
Task Description: ____________________               Powder-Actuated Tool User                                            HOUSEKEEPING:
___________________________________                  Competent Person (lead, asbestos,
                                                                                                            9. Are trash receptacles available in the work
___________________________________                  excavations, confined space,
                                                                                                               area?
Does task require special training?                  hazardous material, scaffolds)                  
                                                                                                               Location: ___________________________
                                                     Other (specify)                                 
                           Yes  No
If yes, what type?                                                                                                        FALL PROTECTION:
                                                                GENERAL INFORMATION:
_______________________________________                                                                     10. Have areas been identified as requiring fall
                                                     1.   Should Safety/Representative be involved in the
_______________________________                                                                                 protection systems and have they been
                                                          planning of this task?  Yes  No
                                                                                                                installed? (i.e., static lines, barricades,
          PERSONAL PROTECTIVE                        2. What are the hazards associated with the                hole covers, etc.)  Yes  No
          EQUIPMENT REQURIED:                           task? ______________________________                    Explain: __________________________
                                                        ___________________________________                     __________________________________
                Yes     No        Type
Fall Protection               ___________               Have they been explained to the                                 FIRE PROTECTION:
Eye/Face                      ___________               employees?                Yes        No         11. Are flammable/combustible materials
Respirator                    ___________                                                                    stored, separated, inspected and secured
                                                     3.    What weather conditions could affect the                                     Yes  No
Foot                          ___________               safety performance of this task?
                                                                                                               per procedure?
Hand                          ___________               ___________________________________
Hearing                ___________                                                                                   ASSIGNED EMPLOYEES:
Coveralls                     ___________                       TOOLS & EQUIPMENT:
                                                                                                                   Name                             Badge #
                                                                                                            _______________________                 _______
                                                     4.    User inspection is required of all tools,        _______________________              _______
PPE Examples: Monogoggles, face shield,
                                                          ladders, electrical cords, rigging and safety     _______________________              _______
acid hood, sandblasting hood, welding (goggles,           equipment. Has this been completed?
shield, sleeves), ear protection, gloves (leather,                                                          ______________________                  _______
                                                                                    Yes  No               _______________________                 _______
chemical resistant, gauntlets), shin/foot
                                                                                                            _______________________                 _______
protection, boots (rubber/hip), rain suit, life                    MATERIAL STORAGE:                        _______________________                 _______
vest, safety harness, fall protection equipment,     5.   Has a material storage area been identified       _______________________                 _______
breathing air assembly.                                   and approved?              Yes  No                         MY SAFETY PRINCIPLES
   PROCEDURES/PERMITS REQUIRED:                                   SCAFFOLDS/LADDERS:
                                 Yes    No           6.   Inspect all scaffolds/ladders before use.            Plan Every Job
   Anticipate Unexpected Events         1. Was anyone injured or did an unplanned incident
                                            occur today? If yes, explain.
   Use The Right Tool For The Job                                    Yes _____ No _____
                                            ________________________________________
                                            ________________________________
   Use Procedures As Tools
                                         2. Was the accident/incident reported to the safety
   Isolate The Equipment

   Identify The Hazards
                                            department? Yes _____ No _____

                                         3. What problems were encountered with today’s
                                                                                               SAFETY
                                            work assignment?




    Minimize The Hazards

    Protect The Person
                                            _______________________________________
                                            _______________________________                      TASK
   Assess People’s Abilities
                                         4.   What can be done tomorrow to improve
                                              performance?
                                              _______________________________________
                                                                                                    ASSIGNMENT
                                              _______________________________
   Audit These Principles
                                         5. Miscellaneous concerns:
                                            ________________________________________
                                            ________________________________

                                         6. Reviewed by:
                                            Supervisor:
                                            General Foreman:

                                                  ASSIGNED EMPLOYEES:
                                               NAME                           BADGE #
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
                                         ______________________              _____________
TURN FORM IN TO PROJECT/SITE
MANAGEMENT AT END OF SHIFT OR WHEN
                                         ______________________              _____________
TASK IS COMPLETED.



      POST SAFETY TASK REVIEW:
                                                         UNITED
SUPERVISOR: _________________________                        JUBAIL
DATE: ________________________________

								
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