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©2019 Delta Services LLC.
Safe Plan of Action
Date
MM slash DD slash YYYY
Nearest Hospital or Medical Facility:
*
Nearest Protective Device:
*
Project:
*
Location of Job:
Job/Task:
Work Area:
TASKS TO BE PERFORMED:
Working from height
Working on energized components
Operation of Powered Industrial Equipment (Fork Lift, Lull, etc.)
Work on machines, circuits, panels or other electrical components
Bending, cutting, installing conduit
Pull wire and terminate
Use of hand and/or power tools
Use Ladders to access work
Pulling wire
Terminations
Material handling
Cut strut, rod conduit & tray
Bend and thread conduit
Drill and KO holes
Install conduit, tray & hangers
Install cabinets, devices, VFD
Troubleshooting systems
Welding supports
TASKS TO BE PERFORMED:
*
HAZARDS ASSOCIATED WITH TASK:
Falls from height
Potential shock or arc flash exposure
Unsafe operation of Powered Industrial Equipment
Hand/eye injury
Slips/trips/falls
Pinch points
Soft Tissue injury (back, strain, sprain, etc.) from lifting, pulling, or moving objects
Falls from Ladders
Cuts abrasions
Other trades in area
Hand hazards
Manual lifting, slips, trips
Hand eye & power tool hazards
Falls, lifting, hands, pinch points
Dialectical hazards
Fires, burns, flash
HAZARDS ASSOCIATED WITH TASK:
*
SAFE PLAN:
All employees exposed to falls will be trained and use appropriate fall protection
Only trained personnel will work near exposed conductors and use appropriate Arc Flash gear
Only trained employees will operate Powered Industrial Equipment
Lockout equipment and assure all energy is controlled
Wear proper eye protection
Wear high visibility vest
Be trained on proper tool usage
Wear proper gloves
Use proper lifting technique
Ask for help with heavy items
Be aware and alert of surroundings
Clean up your work site
Store rolling material or debris safely
Tie off in lift
Hand placement, PPE
Job site awareness
Hand placement, gloves, glasses
Safety glasses
LOTO as needed
Electrical safe practices
Welding gloves, hood, sleeves
SAFE PLAN:
*
Foreman:
*
Foreman Email to receive copy of SPA for reference:
*
Foreman signature:
*
Team Members:
Team Member signatures:
*
Team Member signatures:
Team Member signatures:
Team Member signatures:
Team Member signatures:
Team Member signatures:
