Page 143 - Safety Memo

S SA AF FE ET TY Y T TA AS SK K A AS SS SI IG GN NM ME EN NT T ( (S ST TA A) ) Personal Protective Equipment Required: Permits and Practices Required:
Fall Protection Hand (Gloves)
One STA will be completed before each shift for each task.  Full-Body Harness  Leather  Rubber  Hot Work  Barricades
Post this STA in an obvious place during the length of the  Retractable  Welding  High Voltage  Lock/Tag/Verify  Aerial lifts
task. Each crewmember involved with the task will sign  Other Systems  Neoprene  Kevlar  Excavation  MSDS
this STA. If deviation from safe work practice/procedure Eye/Face  Energized Electrical Work
occurs, WORK MUST BE STOPPED AND THE  Safety glasses with side-shields  Confined Space
JSA/STA REVISED.  Goggles  Monogoggles  Crane Lift
 Welding Hood  Face Shield  Roof Access
STA INSTRUCTIONS: Respirator  Environmental Compliance
1. List job steps associated with task.  Qualified  Respirator Type ______________  Other (specify) __________
2. List hazards associated with job steps. Foot
3. List safe work practices to eliminate the hazards  Safety-Toed Boots  Metatarsal
4. Conduct post safety meeting. Head General Employee Safety Concerns: Answer the
5. Submit completed STA to Contract Management after  Hard Hat following questions Yes, No, or N/A:
each shift. Hearing Protection a. Should a Safety Rep be involved in the planning of
 Ear Plugs  Ear Muffs this job? __________________________________
Clothing b. Could weather conditions affect the safe performance
Employee(s) Assigned: Badge/ID:  Natural Fiber  Fire Retardant (FR) of this task? ____________________
____________________________ _______  Chemical Resistant c. Have all tools, electrical cords, rigging, and safety
equipment been inspected? ______________
____________________________ _______ Other PPE required: ____________________________ d. Has a material storage area been identified and
____________________________ _______ approved? ________________________________
____________________________ _______ Competent Persons Required: e. Have all scaffolds and ladders been inspected? Have

____________________________ _______  Crane Operator scaffold tags been signed? _______________
____________________________ _______  Forklift Operator f. Is a fire watch or confined space attendant required?
_________________________________________
____________________________ _______  Mobile Equipment Operator g. Do you know how to summon help? ____________
____________________________ _______  Vehicle Operator h. Housekeeping conditions?
____________________________ _______  Powder-Actuated Tool User ________________________________________
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Excavations
____________________________ _______  Scaffolds i. Have areas been identified as requiring fall protection
____________________________ _______  Ladders systems and have they been installed? ___________
____________________________ _______  Confined Spaces j. Are flammable/combustible materials stored,
____________________________ _______  Other (specify) separated, and secured? ______________________
 Lead/Asbestos k. Who is the Plant Operations contact? ___________

(1) TASK STEPS (2) IDENTIFIED HAZARDS (3) SAFE WORK PRACTICES
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