KBR / ITI TOTAL SAFETY TASK INSTRUCTION
Employee InvolvementEmployee InvolvementGiven at Task LocationGiven at Task Location
Every TaskEvery TaskEvery DayEvery Day
Exact Location where work is done: ______________________________________________ PPE Assessed by: __________________________________Date: ______________ Time From: ____________________ To: ___________________ Supervisor/Designee:____________________________
Step 1 - Job Description Permit # _______________
Supplied Air Respirators/SCBA Chemical Protective Clothing Electrical Lock-Out Asbestos Abatement Excavations and Shoring Crane-Suspended Work Platform Working on Energized Electrical Circuit Line Breaking Demo Process Piping
Tools/Equipment To Be UsedList All Equipment Needed for Job Task
Hand Tools Step Ladder Extension Ladder Forklift (Licensed Operator) JLG/Manlift (Licensed Operator) Cordless Drill Motor Electric Drill Motor Reciprocating Saw Porta-Band Saw Circular Saw Extension Cord Mule Hand Grinder Pencil GrinderOther
Walkway Clean / Work Area Clean Tools, Materials & Equipment Stored Properly Trash & Scrap Metal Placed in Correct Containers Hazardous Waste Disposal Other_____________________________
YES NO 1. Have Hazards/Risks for this job been assessed to ensure appropriate safety precautions and proper controls?YES NO 2. Did pre-job briefing & training provide adequate information to perform the job task?YES NO 3. Did Supv/Designee provide adequate preparation by conducting a walk-through & completing TSTI at the task location?YES NO 4. Are you familiar with the job performance standards required for this job task?YES NO 5. Do you have an adequate level of experience to perform this task?YES NO 6. All persons are trained and qualified on the tools and equipment they plan on using to perform the task?YES NO 7. Have all tools and equipment used for this job task been properly inspected?YES NO 8. Did communication with other affected personnel about activities which may represent a hazard/risk take place?YES NO 9. Have proper precautions been taken for others in the immediate work area that may be affected?YES NO 10. Is the work area free of housekeeping deficiencies, slippery walking surfaces and unsafe conditions?YES NO N/A 11. Are all employees familiar with, or has MSDS been reviewed for, any hazardous substance that may be present?YES NO N/A 12. Has the line/equipment been drained, depressurized, and decontaminated?YES NO N/A 13. Has the area been barricaded or stand-by posted?YES NO N/A 14. Has LOTO equipment been walked out and verified?YES NO N/A 15. Has each affected employee attached personal lock/tag to the lock out?YES NO N/A 16. Have Stop-work conditions been discussed and reviewed?
Employee/Additional Comments
Barricades (Tape / Signs) Equipment / Grounding / GFCI Fire Blanket / Extinguisher / Hose Fire Watch _____________________________ Entry Attendant__________________________ Fresh Air / Ventilation Equipment Ladders / Scaffolding Fall Protection Device / System Safety Shields / Netting Safety Shower & Eye Wash Vapor Proof / Low Voltage Lighting
Step 2 - Planning
Hazard Communication
MSDS Available Discuss Health Hazards
Step 4 - Verification
DO NOT BEGIN WORK if any questions are answered “NO”… Notify your supervisor for consultation. Your Supervisor can provide on-the-job training, change the crew mix, correct the condition or halt the job.
Air Monitor ____________________________ Body Protection _________________________ Bunker ______________________________ Chemical Resistant ____________________ Disposable (Tyvek, Etc.) ________________ Flash Suit ____________________________ FRC ________________________________ Rain Slicker Suit ______________________ Other ________________________________ Eye & Face Protection ____________________ ANSI Safety Glasses____________________ Face Shield ___________________________ Goggles-Chemical _____________________ Goggles-Impact _______________________ Goggles-Burning ______________________ Foot Protection _________________________ Chemical Resistant _____________________ Safety-Toed___________________________ Hand Protection Chemical Resistant__________ Cotton/Canvas Cloth ___________________ Electrical Insulated _____________________ Latex ________________________________ Leather_______________________________ Leather Insulated ______________________Head Protection _______________________ Hearing Protection______________________ Respiratory Protection ____________________ Air Purifying-Half Face ________________ Air Purifying-Full Face _________________ Air Purifying-PAPR ___________________ Air Supplied _________________________ Air-Supplied w/Egress _________________ SCBA ______________________________ Other__________________________________
Step 3 - See Reverse Side
Step 5 - See Reverse Side
Job Walkthrough/Housekeeping
Personal Protective EquipmentSpecialized Operations
Personnel Protection Devices
(Instruction A)(Instruction B)(Instruction C)
(Instruction F)(Instruction G)
(Instruction H)(Instruction I & M)(Instruction O)
Rev. 01/11
Evacuation Routes Identified & Checked. Alarm Codes Reviewed Wind Direction Reviewed Muster Point / Assembly Area / Safe Shelter ____________________________ Telephone Numbers SECURITY (EMERGENCY) _______________________________
Emergency Action Plan
Sequence of Basic Job Steps/Tasks
1
2
3
4
5
6
Sequence of Basic Job Steps/Tasks
7
8
9
10
11
12
Materials disposed of properly
Work Area Clean-up completed6-4444
Management of Change
Yes (Client Notification Required) No
Manlift Inspected Forklift Inspected Test Equipment current Bucket Truck Inspected Glove (high voltage) Tested and Current Rubber Mats Tested and Current Flash Suit Clean Scaffolding / Inspected
Equipment / PPE Inspection
Management Controls / Work Activity Hazards "WORKSHEET"
Management Controls (see definitions sheet)
R
emo
ve
R
epla
ce
E
nc
lose
G
uard
Sa
fe Sy
stem
Written
P
roced
ure
Ad
equ
ate S
up
ervis
ion
Cla
ssroo
m
Sk
ill Tra
inin
g
PP
E
Describe Controls
Work Activity Hazards
PH
YS
ICA
L
Fall from height
Falling objects
Slip, trip, fall
Crushing
Cuts / abrasion
Pinching
Impact
Entanglement
Fire / explosion
Engulfment (1)
Pressurized systems
Hot / cold surfaces
Flying debris
CH
EM
ICA
L
Hazardous (2)
Dust / Fibers (3)
Fumes (4)
Mist / Aerosols(5)
Gases (6)
Vapors (7)
Smokes (8)
Biological (9)
Spill / Release (10)
EN
VR
NM
NT
Heat / cold stress
Excess noise / vibration
Poor local lighting
Drowning
EL
EC
TR
ICA
L
Direct contact
Indirect contact
Short circuit
High voltage
Source of ignition
WO
RK
TA
SK
Repetitive action
Stressful posture
Manual handling
Mental stress
Visual fatigue
CO
NT
RIB
UT
OR
Y Inclement weather
Poor communications
Adjacent work activity
Poor ambient lighting
Rush job
Supervisor/Designee _________________________________ If not completed by supervisor, supervisor must initial here:
Step 3 - Risk Assessment Rev. 11/10
Permitting Energy Isolation Gas Test Confined Space System Override Auth
Fall Protection
Suspended Load No Smoking Drug/Alcohol Cell Phones/Speeding Buckle Up Journey Management
PLEASE CHECK ALL LIFE SAVING RULES THAT WILL APPLY TO JOB TASK:
Top Related