TASK HEALTH, SAFETY AND
ENVIRONMENT PLAN
Use this form to carry out health, safety and environmental planning for a single task or activity where:
the task may lead you or anyone else to be exposed to a significant hazard
you are not able to confirm that everyone associated with your activities will have sufficient knowledge to avoid any risk of harm (think about people accompanying you, visitors and members of the public)
you may be unable to raise help in the event of an incident.
Task description
Location
(attach map and contact schedule for remote locations)
Person responsible for task
Others involved
Date
Hazards to be considered
(check likely hazard groups)
Detail significant hazards you may encounter while performing the task
Chemical (liquids, solids, gases)
Biological (e.g., bacteria, insects, animals)
Physical (e.g., building materials, rubbish, traffic)
Radioactivity
Weather (e.g., heat, solar radiation, glare, cold)
Noise
FO-AUST-KBR-HSE-ADM01017, Rev. 2 (06/04)
Page 1 of 2
Action or equipment to be used to control hazards
(see Standard S7, Personal Protective Equipment)
Kellogg Brown & Root Pty Ltd
TASK HEALTH, SAFETY AND
ENVIRONMENT PLAN
Hazards to be considered (continued)
(check likely hazard groups)
Detail significant hazards you may encounter while performing the task
Topographical (e.g., uneven terrain, surface water)
Structural (e.g., buildings, drains, confined spaces, trenches)
Mechanical (e.g., machinery, vehicles, tools, vibration)
Geographic (e.g., remote location, lone work)
Human (e.g., uncontrolled access, vandalism, sabotage)
Have you briefed everyone likely to be exposed to the hazards identified above?
Yes
No
Has appropriate equipment been provided if a need identified above?
Yes
No
Has someone been advised of your plan and asked to monitor your return?
Yes
No
If task is at a remote or isolated site, what action is to be taken in the event of your non-return?
Are there any circumstances that warrant your seeking additional advice on health, safety and environmental matters before proceeding?
Start time
Plan developed by
Plan approved by
Plan distributed to
Action or equipment to be used to control hazards
(see Standard S7, Personal Protective Equipment)
Expected completion
Yes
No
Date
(Print name)
(Signature)
(Print name)
(Signature)
Date
FO-AUST-KBR-HSE-ADM01017, Rev. 2 (06/04)
Page 2 of 2
Kellogg Brown & Root Pty Ltd