PRE-TASK PLAN AND JOB HAZARD ANALYSIS
Permit #:
Company:
Project Start Date:
Idonia
Work Area: Building 1, 2 & 3
Project End Date:
Description of Work (Clearly Define Scope): Perform Scissor Lift Building 1, 2 & 3 painting for DOSH Inspection.
 Permits are required for the following work but not limited to: (Refer to Facilities Work Permit)

Work performed on the following systems:












Process water – includes deionized water and process cooling water
Non-process water – includes chilled water, hot water, steam, blend water, high temperature hot water, potable water, and non-potable water
Drains – includes industrial waste, solvent waste, sulfuric waste, IPA waste, specialty chemical waste, sanitary waste, and storm
Exhaust – includes acid exhaust, caustic exhaust, VOC exhaust, general exhaust, and specialty exhaust (e.g. Silane and highly toxic)
Vacuum – includes plant vacuum and clean room vacuum
Air – includes make-up air, recirculating air, CRAC, VLF, and FFU
Electrical – includes high voltage, medium voltage, low voltage, UPS, and emergency power
Controls – includes process and life safety
Fire – includes detection, suppression and notification
Chemical and Gas Systems- includes work inside of a chemical or gas room or area, outside or inside of a CDU, gas cabinet, or VMB controls
console; installation or removal of gas lines, chemical lines, CDUs, gas cabinets, and VMBs
Building – includes structural penetrations, clean room ceilings or walls
Work that has specific conditions that could cause an interruption:




Generates loud noises, odors or dust
Involves sheetrock changes that may involve cutting, sanding or painting
Occurs on the weekend or a holiday
Occurs outside but near the building and involves a crane, excavation, or utilities above or below ground
Please describe control and hazard prevention measures in Section F – Job Hazard Analysis for each item marked “Yes”.
Please refer to Section C - Supplemental Documents for each shaded box marked “Yes”.
A. WORKER SAFETY:
1. Is barricading and signage required to protect personnel, facilities or equipment?
2. Will work involve live systems (e.g. hot tap) or energized electrical equipment
3. Is lockout / tag out (LO/TO) of hazardous energies required?
Check type: ☐ electrical, ☐hydraulic-pressurized, ☐ thermal, ☐ mechanical, ☐ chemical, ☐ pneumatic, ☐ radiation,
☐ stored energy, ☐ other: Click here
4. Will work involve the use of a ladder?
5. Will work involve exposure to falls of 4 feet or greater?
Check type: ☐ladders greater than 20 feet, ☐scaffolding, ☐work platforms, ☐ boom lifts, ☐ scissor lifts, ☐ unguarded roof
edge, ☐removing floor tiles or creating an open penetration, ☐other: Click here
6. Will work involve working under overhead work?
7. Will work involve the use of a crane and/or hoist?
8. Will work involve handling of heavy material (guideline: greater than 35 lbs.)?
Check type of controls: ☐ two person lift, ☐ lifting device, ☐ Powered Industrial Truck (e.g. Forklift, electric pallet
jack, etc.)
9. Will work involve ergonomic risks (e.g. vibration, forceful exertion, static posture, contact stress, etc.) and/or awkward
postures?
10. Will the task involve the use of chemicals or be adjacent to process equipment/piping containing chemicals?
a. Are Safety Data Sheets available for review by workers?
b. Are chemicals approved for use on-site as required by the Chemical and Material Screening Program?
c. Will containers be labeled with contents and hazards?
d. Will containers have a designated storage location?
11. Will work generate odors?
12. Will work generate waste or introduce material to an existing waste stream? (Coordinate with ESH Specialist)
13. Does the task require the demolition of systems or equipment? Check type: ☐ electrical ☐ chemical ☐ other: Click
here
a. Has the source disconnection been verified?
b. Has any stored energy been properly released? (e.g. capacitors)
c. Have the lines been verified via slip-ring process?
d. Will it involve demolition or removal through wall/floor/ceiling penetrations? If yes, note column location: Click here
14. Will work involve preparing equipment for movement (orange tagging)?
15. Will work take place in designated arsenic or lead use areas? Check type: ☐ arsenic ☐ lead
16. Will work involve the potential disruption of asbestos-containing materials? (e.g. floor tile, mastic, piping insulation, wall
board, etc.)
17. Will weather conditions affect the safe completion of this task?
18. Will work involve using sharp tools or materials?
Check type: ☐ sawzall ☐ saws ☐ knives ☐ sheet metal ☐ unistrut, ☐ other: Click here
19. Will work involve any activity which may produce a spark, arc or open flame such as cutting, welding, grinding, or
chipping?
20. Will work involve employee exposure to hazardous noise levels ( >85 dB, need to yell to overcome noise)?
21. Will work restrict access to emergency equipment (e.g. Safety shower, eyewash, fire extinguisher) and/or egress
pathway?
22. Will work be conducted in a confined space?
23. Will work involve the use of a laser or other light emitting source (laser level)?
24. Will a worker perform a medium or high risk type task while working alone where assistance is not readily available in the
event of an injury, illness, or emergency? If yes, specify in the JHA - Section G the communication plan.
YES
☒
☐
☒
NO
☐
☒
☐
☐
☐
☒
☒
☐
☐
☐
☒
☒
☒
☐
☒
☒
☒
☒
☒
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☐
☐
☒
☐
☒
☐
☐
☒
☒
☐
☐
☐
☒
☒
☒
B. RELIABILITY IMPACT:
1. Will the work involve or have the potential to impact:
a. Fire Detection and Suppression - Smoke Detectors IR/UV/VESDA, Sprinkler?
b. Safety Shower, Eye wash, Leak detection?
c. Evacuation Speakers or Strobes?
d. Hazardous Gas/Bulk Chemical Distribution Systems?
e. Security/Life Safety Systems (Gas Detection)?
f. Ion Emitter / Particle Counter / Clocks / AMC Monitoring?
g. Process Controls (PLCs, SCADA, hardware, software)?
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
C.
Will work involve climbing or standing on equipment or utility systems? If yes, specify: Click here
Will work involve excavation, digging, drilling or driving materials into the ground?
Does the project involve an equipment move? If yes, provide drawings with your move path.
Do switches, buttons, pipes, gauges, or valves need to be protected or supported?
Has construction power been obtained from an approved non-process source?
Does the work require flushing or discharging of fluids or purging of gases?
Note: Where there is a potential for cross-contamination, ensure a FCCB has been conducted.
Will work involve drilling, coring, or roto-hammering on facility structures?
Will work involve potential runoff into the storm drains? If yes, list how storm drains will be protected in
the JHA – Section F.
Will work involve interruption or redirecting of vehicle or pedestrian traffic? (Coordinate with Security)
Will work involve potential impact to production tools (e.g. EMO/EPO buttons, gas or chemical lines,
cables, hoses, valves, meters, or any work within 20ft. of a tool)?
Will work impact or involve pollution abatement equipment? (Coordinate with ESH Specialist and system
owner)
If work is being performed around manufacturing areas, have supervision and personnel in that area been
notified?
YES
NO
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☐
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☒
☐
☐
☒
☒
☐
☐
☒
☒
☐
☒
☐
☒
SUPPLEMENTAL DOCUMENTS - Are any of the following required to perform task? (check all that apply)
☐ Hot Work Cutting/Welding Permit
☐ Excavation Permit
☐ Odorous Activity Notification
☐ Confined Space (Non-permit, Permit)
☐ Energized Electrical Permit
☐ Fall Prevention Plan / Rescue Plan (Working From Heights)
☐ Crane and Hoist Lift Plan (General, Critical)
☒ Lockout/Tagout Procedure
☐ Decontamination and Materials Movement Checklist (orange tag)
☐ Impairment Form (Fire, Life Safety)
☐Other: Click here
D. PPE (Personal Protective Equipment) - Are any of the following PPE required to perform task? (select all that apply) Note: Check expiration date of
PPE before approval.



Eye Protection
☒Safety Glasses w/ side shield
☐Others: Write here
☐Safety Googles
Face Protection
☐Chemical Face shield
☐Others: Write here
☐Electrical Face shield
Hand protection
☒Chemical Resistant Gloves;
Write type:
☐Electrical Gloves
☐Other: Write here



☐Cryogenic Gloves
☒Other: Anticut glove
Head Protection
☒Hard hat
☐Other: Write here
Body Protection
☐Cryogenic suite
☐Electrical suite
Hearing Protection
☐Ear Muff
☐Ear plug
☐Other: Write here

☐Cryogenic head gear

☐Welding suite
☐Other: Apron

Foot Protection
☐Electrical Safety Shoes
☐Anti-slip safety shoes
Respiratory Protection
☐Cartridge respirator
☒Other: Facemask
Fall Protection
☐Full body harness
☐Other: Write here
☐Rubber boots
☒Other: Safety Shoes
☐Double strap respirator
E.
EMERGENCY INFORMATION (from the work area): Ways to communicate an emergency (Radios (walkie talkies), fire alarm levers and visits to the area
where the work is being performed). Immediately call TI Site Emergency Phone and your supervisor and/or project manager for injury, illness or
facility events. Report “ALL” near misses to your supervisor and/or project manager.
Location (stairwell#, column #, grid line #, equipment ID, etc.)
Write here
Muster Point/Location
Write here
Nearest Exit
Write here
Nearest Phone
Write here
Fire Extinguisher
Write here
Eye wash/shower
F.
Emergency Contact Information (TI Site)
Emergency Phone #
Control Centre (03-42643111)
Supplier Name On-site
Emergency Contact #
Supplier Company Name
Emergency Contact #
Medical Provider Name
Lourdes Poliklinik
JOB TASK and HAZARD ANALYSIS FORM (Please use additional page if needed).
Examine each step in the job task, identify the potential hazards and determine the measures to protect personnel from these hazards. This is
accomplished by 1) listing all the steps required to complete the job including 5S activities, 2) evaluating each step for potential hazards, and 3)
recording the precautions required for completing the task safely.
Be specific in your comments remembering to engineer the hazard out when possible and only resort to providing protective equipment when it is not
possible to remove the hazard. Specifically list personal protective equipment when it is required. Do not use general statement.
Step
1.
2.
3.
4.
5.
Sequence of Basic Job Steps
SAFETY Hazards
Inform TI-ers personnel before 1) Miscommunication.
activity start. Go through SDS with
the workers. Wear and inspect all
PPE and understand JHA.
Barricade and put signage at the
area before start work.
Turn OFF the scissor lift. LOTO. 1) Fall and trip
Verify by observing the scissor lift 2) Electrical Hazard
movement. LOTO will be done and 3) Miscommunication.
varified by TI chargeman.
Cover the floor. Apply painting on 1) Fall and trip
the scissor lift by using brush and 2) Sharp point
paint roller. Paint already registered 3) Chemical Hazard
in Chemreq and ID is 33324.The
paint will dry after 30 minutes.
Remove LOTO and barricade after 1) Fall and trip
all the work is complete. LOTO will 2) Electrical Hazard
be removed by TI chargeman.
3) Miscommunication.
Housekeeping. All the waste will be 1) Fall and trip
disposed by vendor.
2) Sharp point
SAFETY Control
1) Communicate JHA
with employees to
ensure related work
permit in toolbox talk.
RELIABILITY Hazard
N/A
RELIABILITY Control
N/A
1) Make sure stand on
stable grounding
2) Wear safety gloves
3) Communicate JHA with
employees to ensure
related work permit in
toolbox talk.
1) Make sure stand clear
path before walking
2) Wear anticut glove
3) Wear proper PPE as
stated in SDS.
1) Hit piping, valve, panels 1) Make sure the
or sensors
pathway is clear before
2) Damage power switch walking and start with
the activity
2) Handle switch with
care
1) Make sure stand on
stable grounding
2) Wear safety gloves
3) Communicate JHA with
employees to ensure
related work permit in
toolbox talk.
1) Make sure stand clear
path before walking
2) Wear anticut glove
1) Hit piping, valve, panels 1) Make sure the
or sensors
pathway is clear before
2) Damage power switch walking and start with
the activity
2) Handle switch with
care
1) Hit piping, valve, panels 1) Make sure the
or sensors
pathway is clear before
walking and start with
the activity
1) Hit piping, valve, panels 1) Make sure the
or sensors
pathway is clear before
walking and start with
the activity
GENERAL ACKNOWLEDGEMENT
Signature of Supervisor indicates completion of following activities:
1. Work area has been walked by field service personnel to identify safety and/or impact concerns.
2. Area is safe to work in (i.e. housekeeping, guarding, congestion, work surfaces, access).
3. Work has been coordinated with other crews in the area.
4. All tools and equipment are safe and in good condition (includes assured grounding, slings, hand tools, etc.)
5. All necessary training for this task has been completed.
6. All necessary Personal Protective Equipment is available at the job site in proper working condition
7. All new employees have been familiarized with work area.
8. Sufficient personnel have been assigned to complete this task safely.
9. Emergency exits and equipment have been identified (phones, fire extinguishers, eyewashes, etc.).
10. Area has been designated and protected from passersby by cones, safety tapes, barricades, or other means.
11. Contingency plans have been developed for unexpected events (medical emergency and/or equipment failure, Evacuation Employee Roster).
12. Site specific hazard information pertaining to this job has been evaluated by Supplier.
13. There is a daily approval form to be signed by supervisors and workers. Attachment A.
Note to Supplier: By administering this worksheet, Supplier understands that it is responsible for training and PPE obligations for its employees and that
Texas Instruments is in no way undertaking any training responsibilities nor is it warranting to the supplier’s workforce, to its subcontractors, to any
governmental agency, or to the general public, that the contractor’s pre-task planning fulfills any duties or responsibilities owed to these individuals. This
worksheet is administered solely as a “tool” to integrate contractors’ Job Hazard Analysis into the work permit process and to screen out those
contractors that pose an apparent threat to the safety of Texas Instruments employees by not having any process for pre-task planning.
IF WORK SCOPE OR CONDITIONS / ACTIVITIES CHANGE THAT COULD IMPACT SAFETY OR RELIABILITY, WORK MUST STOP
UNTIL PLAN IS REVISED AND REVIEWED BY TI PROJECT MANAGER, FACILITIES RELIABILITY CHAMPION AND ESH.
JHA Approver

Person completing JHA

ESH Representative/Supervisor of the Company

Manager of the Company

TI ESH Representative

Fire Protection System Owner (If work will impact fire protection
system)
N/A

TI Facilities Representative/Project Owner

TI Facilities Director

QRA (If applicable)/Optional
Note: QRA Representative to approve JHA if work is done
inside manufacturing area that will have potential impact to
quality or TI products. Ex. Painting, grinding, opening of
ceiling, etc.
(Name and Signature: required one time)
ATTACHMENT A
(Use separate copy because this will be signed daily before every start of the work)
Participated, Read, Understood and Agreed Prior to Start of Work
Position/Function
Date:
Date:
Date:
Printed name and Signature
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Initial daily BEFORE work begins
Project Supervisor
Area Supervisor
Member/Worker
Member/Worker
Member/Worker
Member/Worker
Original Date:
Participated, Read, Understood and Agreed Prior to Start of Work
Position/Function
Project Supervisor
Area Supervisor
Member/Worker
Member/Worker
Member/Worker
Member/Worker
Original Date:
Printed name and Signature
Date:
Date:
Date:
Date:
Date:
Date:
Initial daily BEFORE work begins