Pre-Task Planning (PTP)
Post completed PTP at the work location. Upon completion of work, file the PTP
with immediate manager/supervisor.
Helping
This form is to be completed whenever non-standard us achieve
hazardous work isZero Harm!
performed and there are no standard procedures available.
1. Identify the Task
Employee Name: ______________________________________________________________ Date: ____________________________________
Description of Work:_______________________________________________________________________________________
Location of Work:__________________________________________________ Tool/Module: _____________________________
2. Identify Personal Protective Equipment (PPE) Based on hazards, identify the required PPE.
Check off all necessary PPE and specify if necessary under Additional Requirements:
Glasses Facemask Hand Head Prot. Fall Prot.
Goggles Respiratory Body Prot. Hearing Foot Prot.
Additional Requirements (if any):
3. Understand the Hazards Identify the potential hazardous work conditions.
Hazardous Energies 电殛 Chemical Exposure 化学品危害
(e.g., electrical, pneumatic, mechanical, (e.g., tool maintenance/service, storage, handling,
hydraulic, gravity, vacuum) spills, inhalation/odor, waste generation)
Work at Height 登高作业 Isolated Work 密閉空間作业
(e.g., > 1.2 m (4 ft) on platforms, > 1.8 m (6 ft) on (e.g., out of hearing or sight range of another
ladders, open floors, unprotected elevated locations) individual)
Confined Space or Asphyxiation Hazard Powered/Manual Hand Tools 电动手动工具
侷限或窒息空間作业 (e.g., electric, pneumatic/air guns, torque
(e.g., limited or restricted means for entry/exit, not wrenches, drills)
designed for continuous occupancy, under raised floor)
Manual Material Handling 人力移动工具 Lifting Equipment 叉車
(e.g., lifting, bending, twisting, moving object, 2 (e.g., crane, hoist, genie lift, forklift, etc.)
man rule, hand truck)
Thermal 熱伤害 Mechanical Hazards 机件伤害
(e.g., exposed bulbs, heat sinks, metal housing (e.g., gears, conveyors, moving parts, robots)
on equipment, cryogens)
High Hand Force 高強度施力 Working with Sharp Objects 尖銳危害施工
(e.g., gripping hand tools and squeezing (e.g., changing blades, broken wafers, broken
scissors) glass)
Vibration 震动施工 Noise 噪音危害施工
(e.g., vibrating power tools) (e.g., noise exceeding 80 dB(A), shouting needed
for conversation at 1 meter away)
Repeated Impact 持続性伤害施工 Repetitive Motion 持続重复性动作
(e.g., impacting with the hand or knee (e.g., performing the same motion over and over
repetitively for extended time periods) again)
Static Posture 長時间靜止 Awkward Posture 困难施作姿态
(e.g. any posture that is held for a long time) (e.g., any uncomfortable/unnatural position held
for more than fifteen minutes)
Non-Ionizing Radiation 非离辐射 Other Hazards 其他危害
(e.g., lasers, IR, RF, UV, microwave)
4. Safe Work Practices
Pre Task Planning Worksheet
Buddy Required 伙伴需要 Lock-out/Tag-out LOTO
Barricade and Signage 路障围离标志 Safety Data Sheet 安全资料表
All necessary tools available and in working
Clean Work Environment (required) 清扫工具
order (required) 其他必需工具
Temporary bypassing of safety functionality
临時性绕开解除装置
(e.g. jumpers installed/removed, pneumatics
swapped, settings changed)
5. Safety Plan Document each step of the procedure. Continue on third page. Add pages as needed. Engage Product Safety / Product
Support / Engineering / EHS as necessary. Document all configuration changes in Section 8 – Troubleshooting Changes Tracker
Complete Date/ Sequence of Basic Potential Hazard(s) Method to
Item
(Initial) Time Job Steps Involved in Current Step Contain Hazard(s)
1. Inform all affected personnel of the planned task.
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5. Safety Plan Document each step of the procedure. Continue on third page. Add pages as needed. Engage Product Safety / Product
Support / Engineering / EHS as necessary. Document all configuration changes in Section 8 – Troubleshooting Changes Tracker
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Pre Task Planning Worksheet
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6. Emergency Preparedness Know how to respond in case of an emergency.
Object Location Comments
Emergency Exit
Emergency Phone
For hot work, a hot work permit must be secured in advance and an
Fire Extinguisher
extinguisher must be in the immediate work area.
Eyewash/Shower Station
Other?
7. Final Review Reach agreement on the pre-task plan with the appropriate parties.
I have reviewed this Pre-Task Plan and agree to the process and control measures described within. My agreement with this Pre-Task Plan does
not imply it is comprehensive, and changes in work conditions or needed process changes may require my further review and input toward
creating a safe work environment.
Employee Signature: ___________________________________________________________________ Date: ___________________
Manager/Customer/Supplier Signature: ___________________________________________________ Date: ___________________
Tool/Platform Owner Signature: _________________________________________________________ Date: ___________________
Prod Safety/Prod Support/Engineering/EHS (if applicable) Signature:_____________________________ Date: ________________
Facilities Manager (if Facilities impacted) Signature: _____________________________________________
Date: ___________________
Additional Hazards Identified After the Start: Stop and restart the PTP process. Submit any procedure/documentation
issues or safety lessons learned from completion of this task as a “Good Catch or Stop Work” in the OneComm SIR System.
Procedure/documentation issues should also generate a document related NC in addition to the SIR.
8. Safety Functionality Bypass Tracker Document each configuration change (jumpers installed/removed, pneumatics swapped, settings
changed, etc.) made during troubleshooting. Engage Product Safety / Product Support / Engineering / EHS as necessary. Return all configuration
changes to normal operating mode before putting tool back in operation.
Returned to
Change Made
Ite Normal
Configuration Changes Made (Time, Date,
m (Time, Date,
Initials)
Initials)
Pre Task Planning Worksheet
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20. Return all configuration changes to normal operating mode before putting tool back in operation.
Pre Task Planning Worksheet
