Date Plan PreparedJob Name: Job Number: Job Location: Pre-Task PlanCompany Name: Author/Planner: Location of Work: Task to be accomplished:Start Date/Time: End Date/Time: Crew Size: Housekeeping Plan (Trash removal, Clean up, responsible person, frequency):Material Storage & Handling Plan (Deliveries, Laydown, Equipment):Access & Hoisting Plan (Personnel & Materials):Please consider the work to be performed and check ‘Yes’ or ‘No’ (attach additional information as needed):1. Does every crew member know how to use assigned tools & equipment? Yes No 2. Does this work require special training? Yes No 3. Do you need additional or special personnel to complete this task? Yes No 4. Do you need additional or special materials and tools to do the job? Yes No 5. Do you need to review an MSDS to proceed with this work? Yes No 6. Is there adequate lighting and access? Yes No 7. Will weather conditions affect the safety or quality of this work? Yes No 8. Does this task require shutdown of systems or equipment? Yes No 9. Is there any potential to impact existing Owner or Construction activity? Yes No 10. Are there occupied spaces adjacent or below? Yes No 11. Have shop drawings, contract drawings, and as-builts been reviewed? Yes No 12. Will there be any discharge of fluids? Yes No 13. Do other subs need to be involved? Yes No 14. Does this task require any special permits/procedures? Yes No 15. Employees are assigned a “buddy”? Yes No 16. Crew knows location of fire extinguishers, eye washes, phones? Yes No 17. Work involves awkward positions, heavy or repetitive lifting? Yes No Check if any of the following apply (attach additional information as needed):Check if any of the following apply (attach additional information as needed): Public Interface Confined Space Electrical Hazards Critical Lift Plan Fall Protection PPE Respirator PPE Traffic Control Chemical Exposure Lock-Out/Tag-Out MSDS/HazCom Hand/Arm PPE Hearing PPE Barricades/Signs Ventilation Open Flame Welding Full Body PPE Eye/Face PPE Construction Activity (In Sequence)Hazards IdentifiedPreparation(NOTE: Attach supplemental information as needed)The tasks have been reviewed in the work area where they will be performed and this plan has been reviewed with the workers on this crew.Foreman Signature: Reviewed by: Phone/Pager: Crew Sign In:IF WORK CONDITIONS CHANGE, WORK MUST STOP AND A NEW PLAN MUST BE PREPARED.CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
