KBR / ITI TOTAL SAFETY TASK INSTRUCTION

Employee InvolvementEmployee InvolvementGiven at Task LocationGiven at Task Location

Every TaskEvery TaskEvery DayEvery Day

Exact Location where work is done: ______________________________________________ PPE Assessed by: __________________________________Date: ______________ Time From: ____________________ To: ___________________ Supervisor/Designee:____________________________

Step 1 - Job Description Permit # _______________

Supplied Air Respirators/SCBA Chemical Protective Clothing Electrical Lock-Out Asbestos Abatement Excavations and Shoring Crane-Suspended Work Platform Working on Energized Electrical Circuit Line Breaking Demo Process Piping

Tools/Equipment To Be UsedList All Equipment Needed for Job Task

Hand Tools Step Ladder Extension Ladder Forklift (Licensed Operator) JLG/Manlift (Licensed Operator) Cordless Drill Motor Electric Drill Motor Reciprocating Saw Porta-Band Saw Circular Saw Extension Cord Mule Hand Grinder Pencil GrinderOther

Walkway Clean / Work Area Clean Tools, Materials & Equipment Stored Properly Trash & Scrap Metal Placed in Correct Containers Hazardous Waste Disposal Other_____________________________

YES NO 1. Have Hazards/Risks for this job been assessed to ensure appropriate safety precautions and proper controls?YES NO 2. Did pre-job briefing & training provide adequate information to perform the job task?YES NO 3. Did Supv/Designee provide adequate preparation by conducting a walk-through & completing TSTI at the task location?YES NO 4. Are you familiar with the job performance standards required for this job task?YES NO 5. Do you have an adequate level of experience to perform this task?YES NO 6. All persons are trained and qualified on the tools and equipment they plan on using to perform the task?YES NO 7. Have all tools and equipment used for this job task been properly inspected?YES NO 8. Did communication with other affected personnel about activities which may represent a hazard/risk take place?YES NO 9. Have proper precautions been taken for others in the immediate work area that may be affected?YES NO 10. Is the work area free of housekeeping deficiencies, slippery walking surfaces and unsafe conditions?YES NO N/A 11. Are all employees familiar with, or has MSDS been reviewed for, any hazardous substance that may be present?YES NO N/A 12. Has the line/equipment been drained, depressurized, and decontaminated?YES NO N/A 13. Has the area been barricaded or stand-by posted?YES NO N/A 14. Has LOTO equipment been walked out and verified?YES NO N/A 15. Has each affected employee attached personal lock/tag to the lock out?YES NO N/A 16. Have Stop-work conditions been discussed and reviewed?

Employee/Additional Comments

Barricades (Tape / Signs) Equipment / Grounding / GFCI Fire Blanket / Extinguisher / Hose Fire Watch _____________________________ Entry Attendant__________________________ Fresh Air / Ventilation Equipment Ladders / Scaffolding Fall Protection Device / System Safety Shields / Netting Safety Shower & Eye Wash Vapor Proof / Low Voltage Lighting

Step 2 - Planning

Hazard Communication

MSDS Available Discuss Health Hazards

Step 4 - Verification

DO NOT BEGIN WORK if any questions are answered “NO”… Notify your supervisor for consultation. Your Supervisor can provide on-the-job training, change the crew mix, correct the condition or halt the job.

Air Monitor ____________________________ Body Protection _________________________ Bunker ______________________________ Chemical Resistant ____________________ Disposable (Tyvek, Etc.) ________________ Flash Suit ____________________________ FRC ________________________________ Rain Slicker Suit ______________________ Other ________________________________ Eye & Face Protection ____________________ ANSI Safety Glasses____________________ Face Shield ___________________________ Goggles-Chemical _____________________ Goggles-Impact _______________________ Goggles-Burning ______________________ Foot Protection _________________________ Chemical Resistant _____________________ Safety-Toed___________________________ Hand Protection Chemical Resistant__________ Cotton/Canvas Cloth ___________________ Electrical Insulated _____________________ Latex ________________________________ Leather_______________________________ Leather Insulated ______________________Head Protection _______________________ Hearing Protection______________________ Respiratory Protection ____________________ Air Purifying-Half Face ________________ Air Purifying-Full Face _________________ Air Purifying-PAPR ___________________ Air Supplied _________________________ Air-Supplied w/Egress _________________ SCBA ______________________________ Other__________________________________

Step 3 - See Reverse Side

Step 5 - See Reverse Side

Job Walkthrough/Housekeeping

Personal Protective EquipmentSpecialized Operations

Personnel Protection Devices

(Instruction A)(Instruction B)(Instruction C)

(Instruction F)(Instruction G)

(Instruction H)(Instruction I & M)(Instruction O)

Rev. 01/11

Evacuation Routes Identified & Checked. Alarm Codes Reviewed Wind Direction Reviewed Muster Point / Assembly Area / Safe Shelter ____________________________ Telephone Numbers SECURITY (EMERGENCY) _______________________________

Emergency Action Plan

Sequence of Basic Job Steps/Tasks

1

2

3

4

5

6

Sequence of Basic Job Steps/Tasks

7

8

9

10

11

12

Materials disposed of properly

Work Area Clean-up completed6-4444

Management of Change

Yes (Client Notification Required) No

Manlift Inspected Forklift Inspected Test Equipment current Bucket Truck Inspected Glove (high voltage) Tested and Current Rubber Mats Tested and Current Flash Suit Clean Scaffolding / Inspected

Equipment / PPE Inspection

Management Controls / Work Activity Hazards "WORKSHEET"

Management Controls (see definitions sheet)

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Describe Controls

Work Activity Hazards

PH

YS

ICA

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Fall from height

Falling objects

Slip, trip, fall

Crushing

Cuts / abrasion

Pinching

Impact

Entanglement

Fire / explosion

Engulfment (1)

Pressurized systems

Hot / cold surfaces

Flying debris

CH

EM

ICA

L

Hazardous (2)

Dust / Fibers (3)

Fumes (4)

Mist / Aerosols(5)

Gases (6)

Vapors (7)

Smokes (8)

Biological (9)

Spill / Release (10)

EN

VR

NM

NT

Heat / cold stress

Excess noise / vibration

Poor local lighting

Drowning

EL

EC

TR

ICA

L

Direct contact

Indirect contact

Short circuit

High voltage

Source of ignition

WO

RK

TA

SK

Repetitive action

Stressful posture

Manual handling

Mental stress

Visual fatigue

CO

NT

RIB

UT

OR

Y Inclement weather

Poor communications

Adjacent work activity

Poor ambient lighting

Rush job

Supervisor/Designee _________________________________ If not completed by supervisor, supervisor must initial here:

Step 3 - Risk Assessment Rev. 11/10

Permitting Energy Isolation Gas Test Confined Space System Override Auth

Fall Protection

Suspended Load No Smoking Drug/Alcohol Cell Phones/Speeding Buckle Up Journey Management

PLEASE CHECK ALL LIFE SAVING RULES THAT WILL APPLY TO JOB TASK: