Form 000.653.F0315
Job Hazard Checklist
Prepared By:
Date:
Project:
Work Location:
Brief Description of Project/Task Order
This Job Hazard Checklist must be issued as part of the bid package to communicate health, safety, and environmental hazards
and personal protective equipment to prospective bidders. This checklist contains information obtained during preliminary
planning for this project and may not address all hazards. Additional information/details are provided to the subcontractor
following contract award. This checklist is intended as a “safety starting point.”
Hazards Identified (for any identified hazard, provide a brief description below)
Abrasive Blasting
Excavation > 5 ft deep (> 4 ft in WA)
Noise
Asbestos
Falls > 6 ft
Operating Rotating Equipment
Coal Tar Pitch Volatiles
Hazardous Materials
Overhead Cranes in Area
Confined Space Entry
Hexavalent Chromium
Overhead Electrical Lines
Dock (around water activity)
High Traffic Area
Railroad Activity
Electrical – High Voltage (> 1,000 volts)
Hot Work
Refractory Ceramic Fiber
Electrical – Low Voltage (< 1,000 volts)
Lead
Mobile Equipment (that always has the
Roof Access Required
Electrical – Static
right-of-way)
Silica
Corrosives (specify the corrosive):
Dust (specify what kind of dust):
Other (specify):
Brief description of all hazards identified above:
Conditions and Permits Anticipated
List conditions particular to the worksite:
Check anticipated work permits/contractor submittals:
Asbestos Work Plan
Energized Electrical Work Permit
Job Safety Analysis
Break-In Permit
Fall Protection Work Plan
Line Break Permit
Confined Space Permit
High Voltage Work Plan
Lockout/Tagout
Critical Lift Permit
Hot Tap Permit
Roof Access Permit
Emergency Plan
Other (specify):
Hot Work (Welding/Burning) Permit
Steel Erection Plan
Specify environmental issues/permits:
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Page 1 of 3
Health, Safety, and Environmental
Form 000.653.F0315
Job Hazard Checklist
Training Anticipated
Subcontractor Training – As required by applicable standards, personnel must be trained, and possibly certified, to do the work
they are contracted to do. Proof of training/fitness to do the work must be provided upon request.
Check anticipated training (includes but is not limited to):
Asbestos
Electrical High Voltage
Lead
Bloodborne Pathogens
Equipment Operation
Lockout/Tagout
Confined Space
Fall Protection
PCBs
Crane Operator
Hazard Communication
Respiratory Protection
Dangerous/Hazardous Waste Handler
Hexavalent Chromium
Scaffolding
Electrical (general)
Ladder Use
Lockout/Tagout
Other (specify):
Mandatory Personal Protection and Safety Equipment Requirements
The following 3 items are required on all projects and for construction-type work in office areas:
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Long pants and shirt with minimum 1/2 sleeves
“Substantial” footwear — construction work boots/shoes (canvas shoes of any type are not allowed)
Nonconductive frame safety glasses meeting ANSI Z87.1 (2003) criteria
Hard hats meeting ANSI Z89.1 criteria
Additional Protective Devices/Controls Anticipated
Check all that apply:
Air Monitor
Gloves
Personal Exposure Monitoring
Barricades/Safety Cones
Goggles
Radiation Clothing
Coveralls
Ground “Spotter” for Lifts/Equipment
Reflective Vests
Disposable Coveralls
High Voltage Escort
Retrieval Tripod
Ear Plugs/Muffs
Lab Coat
Respirator
Face Shield
Lifeline
Safety Shower/Eye Wash
Fall Protection
Local Exhaust
SCBA
Fire Extinguisher
Lockout/Tagout
Silt Fence/Erosion Control
Flame-Retardant (FR) Clothing
MSDSs
Hazardous Waste Clothing:
Level A
Level B
Spats (a cloth or leather “gaiter” covering
Level C
Level D
the instep and ankle)
100% Cotton Shirts (long sleeve) and
100% Cotton Pants
Other (specify):
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Page 2 of 3
Health, Safety, and Environmental
Form 000.653.F0315
Job Hazard Checklist
General Site Information/Expectations
First Aid, Medical Treatment, and Emergency Medical Response – subcontractor must provide as required by applicable standards; P2S
employees are on site to provide assistance (signing a Hold Harmless clause may be required to use onsite/client-provided services, if available).
Substance Abuse – conformance to onsite/client policy may be required.
Plant-Specific Safety Rules – contained in the HSE Management System.
Project-Specific Safety Rules (when subcontractors are expected to comply with requirements that go beyond the HSE Management System) –
covered in the pre-task meeting.
Environmental Management – covered in the pre-task meeting.
Housekeeping and other basics:
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Subcontractors are expected to maintain a clean, safe jobsite, including ongoing and daily cleanup.
Refuse, cords, cables, etc., are kept clear of walking surfaces.
Subcontractor provides receptacles for trash, welding rod, scrap wire, etc.
Passageways and walkways are kept free of debris.
Cords, plugs, ladders, fall protection equipment, and tools are inspected and marked with contractor identifier. A GFCI is required on
all extension cords and power tools.
No riding in the back of pickup trucks.
No live electrical work without a special permit.
The contractor prepares and furnishes a Job Safety Analysis using Form 000.653.F0100 or similar. Depending on the job, other hazard
analyses may be required. The JSA is prepared from the information obtained in this checklist, the site visit, the pre-task meeting, and
contractor’s knowledge and experience.
Pre-construction meeting is conducted by the P2S and may be attended by representatives from Contracts and Procurements, Safety,
Environmental, Security, and other subject-matter areas.
Plant-specific subcontractor employee orientation may be required.
Sanitary washing facilities.
Unless otherwise identified in writing, P2S does not furnish any equipment for use on this contract; the subcontractor furnishes all lifting,
mobile, safety, and other equipment for the job. No work is performed without authorization by a P2S purchase order. Any work
performed without an authorized P2S purchase order is at the subcontractor’s risk and expense.
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Selection of Safe Subcontractors – subcontractors are to have the attitude, awareness, and capacity to protect their employees and others
from injury, and can demonstrate the ability to fulfill their obligations under the contract and under the law.
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Subcontractor agrees to bring on site only lower-tier contractors that meet P2S HSE requirements including, but not limited to, acceptance
by P2S of the safety prequalification for the potential lower-tier contractor(s).
Monitoring/Auditing/Inspecting – conducted by P2S and contractor personnel.
Event Notification, Investigation, and Reporting – an Incident Investigation Report (Form 000.653.F0198 or similar) is filed with P2S
on any incident* that occurs at the project worksite. The preliminary report must be completed within 24 hours.
*
Note:
Incident that causes:
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injury (no matter how slight)
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illness (no matter how slight)
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fire/explosion
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property/equipment damage (whether P2S-owned/leased or contractor-owned/leased property/equipment)
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release of “stored” energy
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excavation cave-in/collapse
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unearthing/discovery of any “structure” or human remains
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spill, airborne, or waterborne release into the environment
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near miss/near hit with the potential to result in any “incident” listed above
This form is referenced in Practices 000.653.1003 and 000.653.1304.
Copyright © 2009, P2S. All Rights Reserved.
Form Date: 01May2009
Page 3 of 3
Health, Safety, and Environmental