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Fo Aust KBR Hse Adm01017

This document outlines a health, safety and environment plan template for tasks. The plan requires details of the task, location, hazards, controls, briefings and approvals. It is to be used for tasks that involve exposure to significant hazards, confirmation that all involved have sufficient knowledge, or an inability to call for help if an incident occurs.

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101 views2 pages

Fo Aust KBR Hse Adm01017

This document outlines a health, safety and environment plan template for tasks. The plan requires details of the task, location, hazards, controls, briefings and approvals. It is to be used for tasks that involve exposure to significant hazards, confirmation that all involved have sufficient knowledge, or an inability to call for help if an incident occurs.

Uploaded by

gfg
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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TASK HEALTH, SAFETY AND

ENVIRONMENT PLAN
Use this form to carry out health, safety and environmental planning for a single task or activity where:
the task may lead you or anyone else to be exposed to a significant hazard

you are not able to confirm that everyone associated with your activities will have sufficient knowledge to avoid any risk of harm (think about people accompanying you, visitors and members of the public)

you may be unable to raise help in the event of an incident.

Task description

Location

(attach map and contact schedule for remote locations)


Person responsible for task
Others involved

Date

Hazards to be considered
(check likely hazard groups)

Detail significant hazards you may encounter while performing the task

Chemical (liquids, solids, gases)

Biological (e.g., bacteria, insects, animals)

Physical (e.g., building materials, rubbish, traffic)

Radioactivity

Weather (e.g., heat, solar radiation, glare, cold)

Noise

FO-AUST-KBR-HSE-ADM01017, Rev. 2 (06/04)

Page 1 of 2

Action or equipment to be used to control hazards


(see Standard S7, Personal Protective Equipment)

Kellogg Brown & Root Pty Ltd

TASK HEALTH, SAFETY AND


ENVIRONMENT PLAN
Hazards to be considered (continued)
(check likely hazard groups)

Detail significant hazards you may encounter while performing the task

Topographical (e.g., uneven terrain, surface water)

Structural (e.g., buildings, drains, confined spaces, trenches)

Mechanical (e.g., machinery, vehicles, tools, vibration)

Geographic (e.g., remote location, lone work)

Human (e.g., uncontrolled access, vandalism, sabotage)

Have you briefed everyone likely to be exposed to the hazards identified above?

Yes

No

Has appropriate equipment been provided if a need identified above?

Yes

No

Has someone been advised of your plan and asked to monitor your return?

Yes

No

If task is at a remote or isolated site, what action is to be taken in the event of your non-return?

Are there any circumstances that warrant your seeking additional advice on health, safety and environmental matters before proceeding?
Start time

Plan developed by

Plan approved by
Plan distributed to

Action or equipment to be used to control hazards


(see Standard S7, Personal Protective Equipment)

Expected completion

Yes

No

Date
(Print name)

(Signature)

(Print name)

(Signature)

Date

FO-AUST-KBR-HSE-ADM01017, Rev. 2 (06/04)

Page 2 of 2

Kellogg Brown & Root Pty Ltd

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