Project No. Task Order/Contract No.

: Date:

Prepared By:
Company Name:
Building: Area:
Work Scope/Description:

Primary Project HSE

Emergency Contact Person(s):
Emergency Radio/Phone No.:
Specific Work Location(s):

Pre-Task Walkthrough Conducted: Yes No HSE Program Reference (***): Corporate/000 Project-Specific

KNOWN OR POTENTIAL HAZARDS

Yes No Yes No
17. Respiratory
1. Radiation Area Work  • ***.653.2300/RWP  ***.653.3002
Hazards
18. Noise
2. Hazardous Waste Operations  • 29 CFR 1910.120  ***.653.3003
Exposure
19. Temperature
3. Confined Space  •  ***.653.3322 ***.653.2000/2003
Extremes
20. Hoisting &
4. Hot Work  • ***.653.3101   ***.653.3201
Rigging
21. Repetitive
5. Roof Work •  ***.653.3304 ***.653.2009
Motion
22. Awkward
6. Fall Hazards (> 6 ft)  •  ***.653.3001 ***.653.2009
Positions
23. Same
7. Excavation/Trenching •  ***.653.3311 ***.653.2009
Position(s)
24. Biological/
8. Ladders and Scaffolding  •  ***.653.3302/3303 ***.653.2101/2103
Vermin
25. Insects/
9. Aerial Lifts  ***.653.3204 ***.653.2102/2103
Varmints
26. Signs and
10. Heavy Equipment   ***.653.3200 ***.653.3301
Barricades
11. Lock and Tag  •  ***.653.3315 27. Sharp Objects

12. Site/Vehicle Traffic ***.653.3211 28. Hexavalent Chromium ***.653.2011

29. Grating/Floor Plate/
13. Electrical Hazards  •  ***.653.3309 ***.653.3323
Guardrail Removal
14. Asbestos Work  •  ***.653.2006 30.

15. Lead Work  •  ***.653.2005 31.

16. Hazardous Materials/MSDS  ***.653.3102 32.

= Requires formal/special training 33.

• = Requires a permit/form/report 34.

 = Requires certification or Competent/Qualified Person designation 35.

Page 1 of 4 Health, Safety, and Environmental

Project No. Task Order/Contract No.: Date:

Error Precursors: Identify all that may be applicable to the job.

Task Demands Individual Capabilities

Time pressure (in a hurry) Unfamiliarity with task – first time

High workload (memory requirements) Lack of knowledge (mental model)

Simultaneous, multiple tasks New technique not used before

Repetitive actions, monotonous Imprecise communication habits

Irrecoverable acts Lack of proficiency/inexperience

Interpretation requirement Indistinct problem-solving skills

Unclear goals, roles, and responsibilities “Hazardous” attitude for critical task

Lack of or unclear standards Illness/fatigue

Work Environment Human Nature

Distractions/interruptions Stress (limits attention)

Changes/departures from routine Habit patterns

Confusing displays or controls Assumptions (inaccurate mental picture)

Workarounds/OOS instruments Complacency/overconfidence

Hidden system response Mindset (“turned” to see)

Unexpected equipment conditions Inaccurate risk perception (Pollyanna mindset)

Lack of alternative indication Mental shortcuts (biases)

Personality conflicts Limited short-term memory

SPECIFIC HAZARD ANALYSIS AND SAFE WORK REQUIREMENTS

Known and/or potential hazards, including any marked “yes” above, are further evaluated, and specific measures are identified on
subsequent pages. This discussion must include identification of the work activity, the specific hazards present, and the safe work
requirements/controls (including a hazards assessment/modification for PPE) to be used to alleviate/control the hazard(s).

MINIMUM DRESS/PPE REQUIREMENTS: Hard Hat, Safety Glasses, Substantial Footwear, Long Pants, Shirt with Sleeves

Supervisor Date HSE Representative Date Industrial Hygiene Date

Page 2 of 4 Health, Safety, and Environmental

Project No. Task Order/Contract No.: Date:

Walkdowns

• Walkdowns are completed in advance of the work.

• Ideally, this review includes walkdown by the employees who will actually perform the task.

• During the walkdown, the work scope is validated and verified, including materials and special tools needed to complete the task.

• The walkdown should consider environmental and workplace factors that may impact critical steps of the task.

• The consistency and thoroughness of walkdowns are improved with the aid of a checklist.

Use the walkdown as an opportunity to observe physical limitations that may exacerbate performance, especially at the critical steps, or
•
hinder execution.

• The results of the walkdowns are incorporated into work packages or documentation preparation.

Safety Task Assignment

• Qualification for the task is first and foremost, but not the only, consideration.

Assigning the right employee to the task is an opportunity for the supervisor to evaluate the risk, complexity, and frequency of
•
performance of the task.

Experience, proficiency, personal readiness, and previous risk-taking behavior should be considered in light of the risk and complexity
•
of the task, as well as how often task has been performed.

Factors related to an employee’s mental, physical, and emotional readiness to work should be considered such as fatigue, illness,
•
emotional stress, and physical disabilities relevant to the task.

Pre-Task Briefings

• Employees should be given the opportunity to talk about what is to be accomplished and what should be avoided.

• Possible negative consequences should be discussed to identify additional controls or barriers needed.

• The supervisor and the employee can develop contingencies for the most likely and worst-case outcomes.

• Such thinking enhances situational awareness and improves application of error-prevention tools at critical points in a task.

Page 3 of 4 Health, Safety, and Environmental

 Job Safety Analysis

Project No. Task Order/Contract No.: Date:

Work Activity Hazards Present Required Safety Measures/PPE

Note: This form is referenced in numerous practices.

Copyright © 2010, Fluor Corporation. All Rights Reserved. Page 4 of 4 Health, Safety, and Environmental
Form Date: 23Dec2010