Pre-Task Planning Template ATC PM

	B	C	E	G	I
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2	Pre-Task Planning Form
3	Pre-Task Planning Form
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5	Prepared By:			Project:
6	Supervisor:			Date:
7	Task/Activity:			Location:
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10	Potential Hazards Present
11		Leading Edge	Hot Work	Flying Particle/Debris	Electricity
12		Air Quality/Vapors	Chemicals (Burns, Inhalation, etc.)	Noise	Slip & Trip
13		Lead/Asbestos	Arc Flash	Struck By	Respiratory Hazards
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15	Hazard Elimination
16		Protective Clothing	Head/Eye/Face Protection	Ear/Hearing Protection	Fire Protection
17		Lanyard/Harness	Barricades/Rails	Adequate Eyewash/Shower	Restrict Area
18		Other
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20	Items To Be Verified
21		PPE Present	Safety Plan Reviewed	First-Aid Kit Identified	First-Aid Training Provided
22		Lockout/Tagout Required?	Emergency Response Plan	Safety Equipment Present	Safety Guards
23		Permitting Obtained	Users/Occupants Informed	SDS	Supervision Present
24		Other
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27	Description of procedure to perform task:
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