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ATTACHMENT C

SAFETY TASK
ASSIGNMENT ROSTER
FOREMAN DATE WORK AREA

HAZARD EMPLOYEE

Fall Protection
Eye Protection
Rigging
Fire protection/Prevention
Hand Tools
Power Tools
Electrical
Hazardous Material
Confined Space Program
Scaffold Safety
Respirators
Cranes
Lock & Tag Procedures
Heat Stress
Hearing Protection
Head Protection
Barricades
Ladders
Floor Openings
Motor Vehicles
Excavation
Asbestos

Other:

STA CHECKLIST

1. Should the Safety Department be involved in the planning of the job?


2. Have All employees been briefed on the hazards associated with the job?
3. Emergency and rescue equipment is located in the following areas:
4. Will weather conditions affect the safe performance of this job?
5. Other Specific Instructions:

H:\000_General\Share\103\Safety\08m-STA-Roster.doc

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