Infectious Disease Control Plan - COVID-19 - Flipbook - Page 34
Approval
Level
Yes
No
Desc. On
Task
Plan?
Attachment
Provided?
Will you be working on systems with Hazardous Energy (actual or potential): chemical,
thermal, hydraulic, pneumatic, electrical, mechanical, kinetic, gravity, etc.? If yes, you
must practice proper hazardous energy control (i.e., Lock-Out Tag Out). All TXC
Employees and vendors involved must use appropriate LOTO tags and devices.
Specialized PPE- Voltage rated gloves, tools, mats, and suit?)
M
Approval
Level
LOCKOUT/TAGOUT (LOTO) (REF. IIPP CHAPTER 8)
Yes
No
Desc. On
Task
Plan?
Attachment
Provided?
EQUIPMENT CHECKLIST
Will you be working on scissor lifts? If yes all TXC employees and vendors must be
trained and authorized with in the past 3 years (contact the safety department if you
need any training). A written PRE-use inspection sheet must be completed for each
scissor lift prior to use.
Will you be working on boom lifts or in a boom truck, if yes all TXC employees and
vendors must be trained and authorized with in the past 3 years (contact the safety
department if you need any training), a written PRE-use inspection sheet must be
completed for each Boom lift prior to use.
M
M
M
Will you be working Powder Actuated Tools, if yes all TXC employees and vendorsmust be
trained and authorized with in the past two years (contact the safety department if you
need any training), “P.A.T. in use” signs must be posted outside every entry way to the use
area. A system for the disposal of used brass must be provided.
M
Will you be operating a Gradall or forklift, if yes all TXC employees and vendors
must be trained and authorized with in the past 3 years (contact the safety
department if you need any training), a written PRE-use inspection sheet must be
filled out for each forklift prior to use.
M
Will you be coring or saw cutting (even if subcontracted)?
U.G. utilities I.D’d
Areas tapped off
Slurry controlled
Core catcher
Approval
Level
Yes
No
L
Desc. On
Task
Plan?
Attachment
Provided?
MISCELLANEOUS HEALTH AND SAFETY
Will your task produce vibration or noise? If yes proper PPE must be worn.
L
Will your task produce dust (grinding, sawing, etc.)? If yes, control measures must be
used.
H
Could your task produce odors which require respiratory protection? If yes, odor
control measures must be used (refer to TEAMWRKX IIPP chapter 6
respiratory protection).
M
Could your task result in leaks or spills of liquids (fire suppression system water, oils, DI
water, chemicals, etc.)? If yes, appropriate spill containment; and control measures
must be used.
M
Reviewed By:
Could you possibly interrupt fire or other safety systems (i.e., testing flow switches,
altering sprinkler systems, etc.)? If yes, indicate system(s) and mitigation plan.
Other:
Print Name
Sign Name
Date
TXC Superintendent:
Vendor Representative:(If
required)
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