S.T.A.R.R.T. Safety Task Analysis Risk Reduction Talk WORK ORDER No: NAME OF PROJECT: TASK CHECKLIST S.T.A.R.R.T. FALL HAZARDS YES NO N/A PERMITS YES NO N/A SAFETY TASK ANALYSIS RISK REDUCTION TALK FALL FROM above 1.8 M /6 Ft HOW WORK LOCATION: SLIPS/TRIPS COLD WORK SUPERVISOR: FALLS FROM LADDERS EXCAVATION DATE: PROPER ANCHORAGE LOTO JOB DESCRIPTION: FLOOR HOLES COVERED CONFINED SPACE POTENTIAL HAZARD / RISK PREVENTIVE MEASURES HARNESS INSPECTED OTHERS: 1. LANYARD INSPECTED HANDS/FINGERS YES NO N/A RETRACTABLE F.A. INSPECTED PINCH POINTS LIFELINE INSPECTED JEWELLERY REMOVED EMERGENCY EQUIPMENT YES NO N/A ELECTRICAL YES NO N/A FIRE EXTINGUISHER/BLANKET LOCKED/TAGGED 2. SAFETY SHOWER/ EYE WASH DISCONNECTED ACCESS/EGRESS INSPECTED MUSTER POINT CHECKED STATUS PERSONAL PROTECTIVE EXCAVATION YES NO N/A YES NO N/A EQUIPMENT SHORED BENCH/SLOPED 3. SAFETY HELMET ACCESS/EGRESS SAFETY SHOES DAILY INSPECTION SAFETY GLASSES, HAND COMPETENT PERSON GLOVES GAS MONITORING CUTTING GOGGLES EQUIPMENT WATCH 4. FACE SHIELD ENVIRONMENT YES NO N/A WELDING HELMET WASTE SEGREGATED & Personal Fall Arrest System COLLECTED PROPERLY HEARING PROTECTION HAZARDOUS MATERIAL SDS AVAILABLE LABELLED AND POSTED 5. SIGNS & BARRICADES YES NO N/A OIL SPILLAGE DEALT FIXED BARRICADE PROPERLY CAUTION TAPE ERECTED HEAT HAZARD YES NO N/A SIGNS ON BARRICADES REST ROOM NEARBY SOUND ALARM / BEACON LIGHTS SUFFICIENT COOL DRINKING FLAG MAN WATER AVAILABLE
1. PLANNING CHECKLIST (SUPERVISOR) YES NO N/A NEAREST ASSEMBLY AREA (Encircle) 1 2 3 4 5
Assigned the right employee and material to the task; We accept responsibility for observing safe behavior & environmental safety while performing this task. Discussed the potential HSE impacts, issues and/or requirements NAME AND DESIGNATION associated with the task; 1 16 Understood the correct procedure for performing the job safely; 2 17 Provided the proper communication and task instructions. 3 18 4 19 2. PLANNING CHECKLIST (EMPLOYEE) YES NO N/A 5 20 Discussed injuring or accidents that could result from this task; 6 21 Provided the communication and task instructions necessary to 7 22 perform the task in an environmentally protective manner; 8 23 Carry out task safely and without any environmental incident. 9 24 10 25 3. EMERGENCY PROCEDURE 11 26 Emergency Phone Number: 12 27 Fire Extinguisher Locations: 13 28 First Aid Kit Location: 14 29 Emergency Vehicle & Driver: 15 30
PROJECT MANAGER SITE SUPERVISOR SITE HSE OFFICER
NAME & SIGNATURE: NAME & SIGNATURE NAME & SIGNATURE:
Project Management signature conforms that the STARRT FORM and its RISK PREVENTIVE measures are FOLLOWED.
S.T.A.R.R.T. FORM RED SEA INTERNATIONAL CO. KSA - HSSE DEPARTMENT