SAFE WORK PLAN

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scope of work template
							                                                                                                                      Rel. Doc. 2.2.6.1



  Occupational Health and Safety Program


                                           SAFE WORK PLAN
JOB LOCATION/DESCRIPTION:

ON S ITE S UPERVIS ION:                                                                                  DATE:

WORKERS:



    STEP 1. HAZARD IDENTIFICATION: Prior to starting any work. Break the job down into its majo r
steps. At each step in the job look for hazards where any of the following might occur: a) Serious Injury.        b) Frequent Injury.
   c) Property or Equip ment Damage.       d) Interruptions to Production. e) Public liab ility & Safety.     f) Environment Impact
   g) Ergonomic Impact. Check the box (double click)           next to the potential loss, identify and list specific informati on in
the lines below.




   STEP 2. CONTROLS FOR HAZARD: Determine and list the Control Measures needed to complete the jo b
safely. At each step of the job, consider such things as: a) Responsibilit ies & Ro le of each worker.       b) Special Tools or
Equip ment required.   c) Applicable Regulatory requirements. d) Orientating or Training Workers.         e) Personal Protective
& Safety Equip ment.    f) Hazard Markings, Caution Ribbons, Tags, Locks.         g) Environmental Procedures.      h) Operating
Procedures. i) Emergency Preparedness.        j) Other.
Check the box (double click)     next to the hazard controls, identify and list specific information in the lines below.




  STEP 3. CONTROLS COMMUNICATED: Discuss the Hazards with all Workers and agree on the
Control Measures. Ensure that this informat ion is communicated to each of your Workers or other persons who may be impacted
by your actions. Use: a) Formal Procedures.        b)Work or Clearance Permits.   c) Daily Tail Board Meeting.       d) Other.
*IMPORTANT: Test to see that all Workers understand the Hazards and the Safe Work Plan.
Check the box (double click)     next to the controls communicated, i dentify and list specific informati on in the lines below.




                                                                                  SIGNED:


  Rev. 1
  Jan. 15, 2004

						
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