SAFETY TASK ASSIGNMENT

The STA should be completed daily for each Procedures/Programs Required Yes No
task. Post this STA in a conspicuous location Yes No After scaffolds/ladders were ‰ ‰
throughout the length of the task. Each Hot Work ‰ ‰ inspected, was the inspection
crewmember involved with the task should sign Lock, Tag, Try ‰ ‰ tag signed?
this STA. At the end of the task, give this STA Trenching/Excavation ‰ ‰ Has a hazard assessment ‰ ‰
to the Project Management. If deviation from Signs/Barricades ‰ ‰ been completed with
known safe work practice/procedure occurs, Confined Space ‰ ‰ chemicals/materials
work must be stopped. Crane Lift ‰ ‰ identified?
Line Breaking ‰ ‰
Supervisor: Hot Tapping ‰ ‰
Has a fire watch or vessel ‰ ‰
attendant been trained and
Job #: Date: Scaffolds ‰ ‰ assigned?
Location of Task: Other (Specify) ‰ ‰
Task Description: Are flammable/ combustible ‰ ‰
Employee Certification Required materials stored, separated,
Yes No
inspected, and secured per
Crane Operator ‰ ‰ procedure?
Does task require special training? Yes No Forklift Operator ‰ ‰
If yes, what type? Mobile Equipment Operator ‰ ‰ Have areas been identified ‰ ‰
Power-Actuated Tool User ‰ ‰ that require fall protective
Personal Protective Equipment Required Competent Person (Lead, ‰ ‰ systems (i.e. barricades,
Yes No Type Asbestos, Excavations, confined static lines, hole covers,
Fall Protection ‰ ‰ space, Hazardous Materials, etc.)?
Body harness; lifelines; barricades scaffolds) Have they been installed? ‰ ‰
Eye/Face ‰ ‰
Other (specify) ‰ ‰
Location of the nearest safety shower:
Mono goggles; face shield; hood General Information
Yes No
Respirator ‰ ‰ Was Safety involved in the ‰ ‰ Where are trash receptacles available?
SCBA; hoseline; HEPA; dust planning of this job?
Foot Protection ‰ ‰ Have the weather conditions ‰ ‰ Evacuation staging area:
Safety shoes; rubber hip boots been considered for the task?
Hand ‰ ‰ User inspection is required on all ‰ ‰
Leather; chemical resistant; gauntlets tools, ladders, electrical cords,
rigging, and safety equipment.
Clothing ‰ ‰ Has this been completed?
Coveralls; welding shield; sleeves; rain
suit; FRC; disposable; life vest
CONTRACTOR
SAFETY PROGRAM
 POST SAFETY TASK
ASSIGNMENT

List all hazards associated with this task! Involved Crew Members 1. Was anyone injured or did an
unplanned incident occur today?
Name Badge # Post STA If yes, explain.
Initial YES NO

2. Was the injury or incident

reported to the safety
department?
YES NO

3. What problems did you have with

What will be done to eliminate/control above today’s work assignment?
hazards?

4. What can we do tomorrow to

improve performance?

5. Miscellaneous concerns:

Supervisor’s Signature

General Foreman’s Signature

RETURN TO SAFETY DEPARTMENT