SAFETY PRE-TASK ASSIGNMENT PERMITS / OPERATIONAL CONTROL
PROCEDURES REQUIRED: LADDERS/SCAFFOLDS:
The SPA should be completed daily for each task. Post this Yes No 6. Inspect all scaffolds/ladders before use.
SPA in a conspicuous location throughout the length of the Hot Work Permit Has the scaffold tag(s) been signed? Yes No
task. Each crew member involved with the task should sign; Excavation Permit
this SPA. At the end of the task, give this SPA to the Does the ladder(s) have current inspections? Yes No
Working at Heights Permit
Project/Site Management. If deviation from known safe Confined Space Entry Permit
work practice/ procedure occurs, work must be stopped. Lifting Permit APPLICABLE PERSONNEL:
Supervisor: ______________Date: ________________ Signs/Barricades OCP 7. Is a fire watch/warden/standby man/flagman/rigger required?
Lockout, Tag out OCP Yes No
Location of Task: ______________________________ Scaffolds OCP Name: _____________________________________
_____________________________________________ Risk Assessment
Task Description: ______________________________ Tool Box Talk IN CASE OF EMERGENCY:
_____________________________________________ Other (specify) _______________________________
_____________________________________________ 8. Identify below the location of the nearest
EMPLOYEE/EQUIPMENT CERTIFICATIONS - Assembly area________________________________
Does task require specific training? Yes No REQUIRED: - Fire Fighting Equipment_________________________
If yes, what type?
Yes No - First Aid Box_________________________________
_____________________________________________ Plant / Equipment (specify) ____________________
HOUSEKEEPING:
PERSONAL PROTECTIVE EQUIPMENT Plant / Equipment Operator (specify) ____________
REQUIRED: Scaffold Insp./Supv/Erector (specify) ____________ 9. Are trash receptacles/bin/containers/drums/boxes etc.
Yes No Type Rigger 1/2/3 (specify) ____________ available in the work area?
Other (specify) _________________ Location: _____________________________________
Head __________
GENERAL
Eyes -- __________ FALL PROTECTION:
INFORMATION
Face __________ 1. Should Safety/Representative be involved in 10. Have areas been identified as requiring fall protection
systems and have they been installed? (i.e., lifelines,
Hearing __________ the planning of this task? Yes No
guardrails, barricades, hole/floor & wall opening covers,
2. What are the hazards associated with the task? etc.) Yes No
Respirator __________ _______________________________________________ Explain: _______________________________________
Hand __________ _______________________________________________ _______________________________________________
Have they been explained to the employees? Yes No
Full body harness __________ FIRE PROTECTION:
Foot __________ 3. What weather conditions could affect the 11. Are flammable/combustible materials stored, separated,
safety performance of this task? inspected and secured per procedure? Yes No
Uniform __________ __________________________________
Others (specify) ________________ __________ ASSIGNED EMPLOYEES:
TOOLS & EQUIPMENT:
PPE Examples: Approved Safety Helmet with chin Name Badge #
_______________________ ________________
strap, Safety Glasses (dark/clear), face shield visor, 4. User inspection is required of all tools, ladders, electrical
_______________________ ________________
disposable coverall, welding (goggles, shield, sleeves), cords, rigging and safety equipment
_______________________ ________________
ear plugs & muffs, hand gloves (leather, nitrile or latex Has this been completed? Yes No
______________________ ________________
coated, chemical gloves, gauntlets,), Safety shoes, boots MATERIAL STORAGE: _______________________ ________________
(rubber),gumboots, high visibility vest, full body _______________________ ________________
harness (with double/single lanyards) fall protection 5. Has a material storage area been identified and approved? _______________________ ________________
equipment, respirator mask, uniforms, etc. Yes No _______________________ ________________
SUPERVISORS SAFETY PRINCIPLES POST SAFETY TASK REVIEW: NATIONAL CONTRACTING CO.LTD. Doc. Ref. : NCCT&D.S.FRM.063
(TRANSMISSION & DISTRIBUTION DIVISION) Revision: 00
Ver. Date: 15/10/2015
SUPERVISOR: ____________________________________ SAFETY PRE-TASK ASSIGNMENT Effective Date: 01/11/2015
DATE: ___________________________________________
Plan Every Job
1. Was anyone injured or did an unplanned incident
occur today? If yes, explain.
Anticipate Unexpected Events Yes _____ No _____
___________________________________________
___________________________________________
Use Procedures As Tools
2. Was the accident/incident reported to the safety
Use The Right Tool For The Job department? Yes _____ No _____
3. What problems were encountered with today’s work
Identify The Hazards assignment?
__________________________________________
_______________________________________
Eliminate/Substitute Hazards
4. What can be done tomorrow to improve
performance?
Minimize/Reduce The Hazards __________________________________________
____________________________
Isolate/Separate the Hazards
Administrative/Engineering Control
5. Miscellaneous concerns:
___________________________________________
_____________________________
SAFETY
Measures
Protect the Person
6. Reviewed by:
Supervisor:
Foreman: _______
___ Pre-TASK
Assess People’s Abilities NAME
ASSIGNED EMPLOYEES:
______________________
______________________
BADGE #
_________________
_________________
ASSIGNMENT
Monitor & Evaluate Effectively ______________________ _________________
______________________ _________________
______________________ _________________
Audit These Principles ______________________ _________________
______________________ _________________
______________________ _________________
______________________ _________________
______________________ _________________
RETURN FORM IN TO PROJECT/SITE ______________________ _________________
MANAGEMENT AT END OF SHIFT OR ______________________ _________________
WHEN TASK IS COMPLETED. ____________________ ________________
