Pre-Task Plan Test HBI- Pre-Task Plan V2 Step 1 of 18 5% PRE-TASK PLAN The supervisor and crew will create this plan establishing safe work practices and common hazard control measures for preventing the occurrence of injuries. Job InformationJob Name:(Required) Job Number: Location of Work: Task Description:(Required) Date(Required) MM slash DD slash YYYY Start Time12:00 AM12:30 AM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:00 AM5:30 AM6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PMEnd Time12:00 AM12:30 AM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:00 AM5:30 AM6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PMDivision(Required)SeattlePortlandMissoulaTri CitiesSpokaneBillingsWork Task & Environment EvaluationAre all HBI employees orientated to the site, familiar with the work environment and have you all reviewed and signed the JHA and SSSP?(Required) Yes No Do not start work until this has been completed Has the work area been walked by the crew to identify safety and/or impact concerns?(Required) Yes No Do not start work until this has been completed Will the task require special permits or plans? (i.e. confined space entry, hot work, fall protection work plan)(Required) Yes No Select Forms Confined Space Entry Fall Protection Work Plan Hot Work Permit LOTO Other Enter other form Has the permit or plan been developed and discussed with the crew?(Required) Yes No Do not start work until this has been completed Will the task involve exposure to falls of 4’ or greater?(Required) Yes No Have you identified the appropriate anchor points, and do you have the necessary fall protection equipment needed to perform the task safely?(Required) Yes No Do not start work until the anchor points have been identified and the necessary equipment is available Will the task expose you or other HBI employees to a fall hazard 10’ or greater?(Required) Yes No Have you developed a Fall Protection Work Plan with Rescue?(Required) Yes No Do not start work until a Fall Protection Work Plan has been completed Will barricading and or signage be required to protect personnel, facilities, or equipment?(Required) Yes No Do you have the necessary equipment needed to proceed?(Required) Yes No Do not start work until the necessary equipment is available Will the task require the use of ladders?(Required) Yes No Do you have the appropriate type and size of ladder to perform the scope of work safely?(Required) Yes No Do not start work until the appropriate ladder is availableHave the ladders been inspected for serviceability and has the inspection been annotated on the HBI Ladder Inspection Tag?(Required) Yes No Do not start work until the inspection has been completed and annotated on the inspection tag Will the task require the use of MEWPs?(Required) Yes No Are the operators and occupants trained, certified, and authorized to operate the MEWP safely?(Required) Yes No Do not start work until MEWP training as been completed.Have the MEWPs been inspected for serviceability and has the inspection been annotated on the HBI MEWP Inspection Tag?(Required) Yes No Do not start work until the inspection has been completed and annotated on the inspection tag Will the task require the LOTO of energized systems?(Required) Yes No Have you identified the hazardous energy sources, their isolation points, and coordinated the shutdown and communication procedures with affected personnel?(Required) Yes No Do not start work until the coordination with affected personnel has been established.Do you have the necessary equipment (locks, tags, hasps, etc.) to effectively control the isolation of the energy source?(Required) Yes No Do not start work until the necessary equipment is available Will the task involve the use of chemicals?(Required) Yes No Has the SDS been reviewed and is the appropriate level of PPE available for use with the hazardous chemical?(Required) Yes No Do not start work until the SDS has been reviewed and the appropriate PPE is available Will the task involve exposure to high noise levels greater than 85 dBA?(Required) Yes No Do you have appropriate hearing protection available?(Required) Yes No Do not start work until hearing protection is available Will the task involve musculoskeletal/ergonomic risk factors? (i.e. repetetive motion, awkward position, joint stress)(Required) Yes No Will an ergonomic “stretch & flex” plan be implemented at the start and end of shift?(Required) Yes No Do not start work until a stretch & flex” plan be implemented. Will inclement weather conditions affect the safe completion of the task?(Required) Yes No Have alternate work locations and/or procedures been established to eliminate or reduce the exposure to inclement weather conditions?(Required) Yes No Do not start work until alternate work areas or procedures have been established and implemented.Have additional provisions such as warming or cool-down areas, tents, or canopies, been established to reduce the effects of inclement weather conditions?(Required) Yes No Do not start work until additional provisions have been established and implemented. Will the task require additional coordination with other crafts in the work area?(Required) Yes No Has coordination been established with the affected crafts?(Required) Yes No Do not start work until coordination has been established with affected crews. Have all tools & equipment been inspected for safe use prior to starting work tasks?(Required) Yes No Do not start work until all tools and equipment have been inspected for safe use. Has all emergency equipment been identified & located? (i.e. fire extinguishers, eyewashes bottles/stations, first aid kits, AED)(Required) Yes No Do not start work until all emergency equipment as been identified & locatedWhat is the evacuation route and designated rally point?(Required) Steps of the Task(Required)Hazards of the Task(Required)Hazard Control Methods(Required)Personal Protective EquipmentPPE(Required) Safety Helmet/Hard Hat Kevlar Sleeves Safety Glasses Respirator Face Shield Full Body Harness Gloves – Cut Level 3 or greater Hearing Protection High Vis Clothing Other (Explain) Other PPE SignaturesBy signing below, I acknowledge that I participated in the creation of this pre-task plan and understand the steps of the task, associated hazards, and hazard control methods.Supporting photos (Optional) Drop files here or Select files Max. file size: 100 MB. Foreman Name(Required) Foreman Signature(Required)Date(Required) MM slash DD slash YYYY Crewmember 1 Name: First Last Crewmember 1 SignatureCrewmember 1 – I agree the above name and signature are my own Yes Crewmember 2 Name: First Last Crewmember 2 SignatureCrewmember 2 – I agree the above name and signature are my own Yes Crewmember 3 Name: First Last Crewmember 3 SignatureCrewmember 3 – I agree the above name and signature are my own Yes Crewmember 4 Name: First Last Crewmember 4 SignatureCrewmember 4 – I agree the above name and signature are my own Yes Crewmember 5 Name: First Last Crewmember 5 SignatureCrewmember 5 – I agree the above name and signature are my own Yes Crewmember 6 Name: First Last Crewmember 6 SignatureCrewmember 6 – I agree the above name and signature are my own Yes Crewmember 7 Name: First Last Crewmember 7 SignatureCrewmember 7 – I agree the above name and signature are my own Yes Crewmember 8 Name: First Last Crewmember 8 SignatureCrewmember 8 – I agree the above name and signature are my own Yes Crewmember 9 Name: First Last Crewmember 9 SignatureCrewmember 9 – I agree the above name and signature are my own Yes Crewmember 10 Name: First Last Crewmember 10 SignatureCrewmember 10 – I agree the above name and signature are my own Yes Crewmember 11 Name: First Last Crewmember 11 SignatureCrewmember 11 – I agree the above name and signature are my own Yes Crewmember 12 Name: First Last Crewmember 12 SignatureCrewmember 12 – I agree the above name and signature are my own Yes Crewmember 13 Name: First Last Crewmember 13 SignatureCrewmember 13 – I agree the above name and signature are my own Yes Crewmember 14 Name: First Last Crewmember 14 SignatureCrewmember 14 – I agree the above name and signature are my own Yes Crewmember 15 Name: First Last Crewmember 15 SignatureCrewmember 15 – I agree the above name and signature are my own Yes Use the + icon next to a crew member name to add additional crew members.Pre-Task Plan RevisionsDescribe the deviations from the original pre-task plan and detail the revised hazard control methods.R1R2R3NotesAdditional Email 1 Send a notification to an additional emailAdditional Email 2 Send a notification to an additional emailIf work conditions change, work MUST STOP and the Pre-Task Plan must be revised. Complete the required items based on your responses before starting work. Do not start work until all HBI employees orientated to the site and have signed the JHA and SSSP.Do not start work until the work area been surveyed by you and the crew to identify safety and/or impact concerns.Do not start work before all permits and plans have been developed and discussed with the crew.Do not start work until fall protection anchor points have been identified and the necessary equipment is available.Do not start work until a Fall Protection Work Plan has been completed.Do not start work until the appropriate ladder is available.Do not start work until the ladder inspection has been completed and annotated on the inspection tag.Do not start work until MEWP training has been completed.Do not start work until the MEWP inspection has been completed and annotated on the inspection tag.Do not start work until hazardous energy sources, their isolation points, and coordinated the shutdown and communication procedures with affected personnel have been established.Do not start work until the necessary LOTO equipment is available.Do not start work until the SDS has been reviewed and the appropriate PPE is available.Do not start work until hearing protection is available.Do not start work until alternate work areas or procedures for inclement weather have been established and implemented.Do not start work until additional provisions for warming or cooling areas have been established and implemented.Do not start work until necessary coordination has been established with affected crafts.Do not start work until all tools and equipment have been inspected for safe use.Do not start work until all emergency equipment as been identified & located.
