NON-STANDARD WORK / PRE-TASK PLAN WORKSHEET Non-Standard Work/Pre-Task Plan Worksheet

INSTRUCTIONS: This worksheet is to be used prior to undertaking non-standard / non-documented work. Complete before engaging in non-standard / non-documented work. Use Part F to develop safe written procedure(s). Intel Owner: Tool ID / Description: Effective Date: Supplier Contact: Brief Description of Work: Pre-Task Planning Checklist Purpose: To mitigate all potential safety hazards before engaging in any non-documented / non-standard work. A. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. SAFETY: Please describe control measures in Section “G” for any Safety item checked “Yes” Are barricading and/or signage required to protect personnel, facilities or equipment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Will work involve live systems or energized equipment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Is lockout/tagout of hazardous energies required? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ECP Template Will work involve exposure to falls of 4 feet or greater for non-construction work or 6 feet or greater for construction work? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Are ladders, MEWP, scaffolds or work platforms needed to perform the task safely? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Does this work involve working around or near overhead vehicles (i.e. Fab automated material handling systems) within 2ft? If so, are hazards controlled? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .