Safe Work Procedure
Enter Name of Procedure
Department and Program:
Date Approved: yr/mm/dd
Date Reviewed:
This Safe Work Procedure must be reviewed any time the task, equipment, or materials change and at a minimum every three years.
DO NOT perform this procedure until you have been appropriately
trained and authorized to do so by your supervisor.
Required Training
Delete this text and list all training that is required prior to completing this procedure.
Required Personal Protective Equipment and Devices Delete this text and the Pictograms that
do not apply. Add any additional personal protective equipment required and devices such as; Dust
Collection ystem! "ume #ood! Push tic$ or %ig etc.
&ye Protection Required Approved Dust 'as$ Required
"ace(hield Required Protective Apron Required
CA Approved a)ety "ootwear Required *ong or loose hair must +e tied +ac$ or contained
#earing Protection Required ,o -ewelry! watches! rings! nec$laces etc.
De)ine type .loves Required .loves must not +e worn when operating this equipment
Protective Clothing Required *a+oratory Coat Required
,/0# Approved Respirator Required "ume #ood Required
"all Protection Required ,o loose )itting clothing
Potential Hazards
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associated with this procedure
Pre-Operational Safety Cec!s
Delete this text and enter Pre(0perational chec$s that must +e completed prior to completing this
procedure. /) there are no pre(operational chec$s to +e per)ormed! Delete this ta+le.
Proi"ited #ctivities
Delete this text and enter any acts that are prohi+ited while completing this procedure. "or example;
Do not mo$e 2"ire #a1ard3
Do not cut tree +ranches with this equipment
Do not cut pieces o) wood with nails in them
Do not leave this equipment unattended while running
Safe $or! Procedure
4. /nspect required personal protective equipment and replace i) required.
5. Put on all required personal protective equipment.
6. Delete this text and continue writing procedure. &nter any caution statements as required.
C#%T&O'(
7.
8.
March 2010-Safe Work Procedures Template http://www.rrc.mb.ca/ide!.php"pid#12$0
9.
C#%T&O'(
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If an emergency situation occurs while conducting this task, or there is an equipment
malfunction, shut the equipment off immediately and follow the lock out procedure.
REPORT #') H#*#RDO%S S&T%#T&O' TO )O%R &'STR%CTOR+S%PER,&SOR &--ED&#TE.)
House!eeping
Delete this text and enter any house$eeping items that are required a)ter completing the -o+.
"or &xample:
&nsure equipment is o)).
Place all materials in their proper storage areas.
&nsure the equipment is sa)e! clean and tidy +e)ore you leave it.
/uidance Documents+ Standards+
#pplica"le .egislation+ Oter(
&nter all documents that apply to this Procedure/<as$.
.uidance Documents:
0perator=s 'anual
CA tandards:
'anito+a Regulation 54:/>9:
5.4 a)e ?or$ Procedures
9.4 Personal Protective &quipment
Date ?ritten: yr/mm/dd
Procedure Developed @y:
Date Revised:
Approved @y: type name o) department chair or manager
Date Approved:
ignature: AAAAAAAAAAAAAAAAAAAAAAAAAAAignature o) Chair/'anager
March 2010-Safe Work Procedures Template http://www.rrc.mb.ca/ide!.php"pid#12$0
