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SAFETY PRE-TASK PLAN CARD
First Name:
*
Last Name:
*
Employee Id:
Company Name:
*
Date:
*
Time:
AM
PM
Emergency Phone:
*
Job Name:
*
Crew:
New Employees
Experienced Partner
List Today's Tasks
Tools/Equipment Required For Tasks
Training Required
Yes
No
Respirators
Powder Actuated Tools
Aerial Lifts/JLG
Forklift
Skidsteer
Hearing Protection
Fall Protection
Inspected Before Use?
PERMITS/INSPECTIONS NEEDED
Yes
No
Digging Permit
Hot Work Permit
Scaffolding
Confined Space
MY HIGH RISK ACTIVITIES FOR TODAY
IDENTIFY POTENTIAL HAZARDS
HAZARD ELIMINATION
Trips/Slips/Falls:
Keep Area Picked Up:
Soft Tissue Injuries:
Stretch and Bend:
Particles in Eye:
Face Shield/Goggles:
Overexertion:
Get Help:
Falls Over 6':
Fall Protection:
Overhead Work:
Toeboards/Netting:
Sprains/Strains:
Lift/Carry Properly:
Fire:
Fire Watch/Fire Ext:
Abrasion/Cuts:
Wear Proper Clothing:
Cave-In:
Sloping/Shoring:
Loud Noises:
Hearing Protection:
Heat/Cold Exposure:
Dress Appropriately:
Electric Shock:
Cords/Tools Inspected:
Pinch Points:
Be In Proper Position:
Lead/Asbestos:
Get the Experts:
Moving Machinery:
Make Eye Contact:
Live Utilities:
Disruption Avoidance:
Working With Chemicals:
Review The MSDS:
Spills:
Containment Needed?:
Tools/Materials:
Tools/Materials:
Dropping to a Lower Level:
Secured In Place:
Installing:
Get The Experts:
Chemical Burn:
Gloves and Protective Clothing:
Elevated Load:
Proper Rigging/Taglines:
List Additional Hazards:
TODAY'S JOB SCOPE UNDERSTOOD?
Yes
No
END OF SHIFT REVIEW
Yes
No
N/A
Work Area Cleaned up?
Permits Turned in and Signed off?
Tools/Equipment put away?
Was anyone on the crew injured today?
FOREMAN REVIEW
Notes:
Foreman Email:
Other Email:
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