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Safety Task Assignment Form

The document is a Safety Task Assignment form used for project management, detailing emergency procedures, planned tasks, hazards, and hazard controls. It includes sections for crew member names and signatures, as well as specific locations for emergency resources. The form is designed to ensure safety compliance and effective communication during work tasks.

Uploaded by

Charlon Grospe
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388 views1 page

Safety Task Assignment Form

The document is a Safety Task Assignment form used for project management, detailing emergency procedures, planned tasks, hazards, and hazard controls. It includes sections for crew member names and signatures, as well as specific locations for emergency resources. The form is designed to ensure safety compliance and effective communication during work tasks.

Uploaded by

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

Safety Task Assignment Work Permit No.

:
_______________

STA
SAFETY TASK ASSIGNMENT
Project Name:

Foreman/ Supervisor: Company/ Dept.

Date: Time: Task Location:

Task Description:

EMERGENCY PROCEDURES

Emergency Phone Number/Channel:

Emergency Assembly Area:

Fire Extinguisher Location:


Eye Wash Location:

First Aid Location:


Other:

Location/Address for Emergency Responders: Safety building/ Clinic

PLANNED TASKS FOR THE SHIFT HAZARDS HAZARD CONTROL

Prepare tools
Secure work permit
Sign to authorize & area custodian
Proceed to activity
Housekeeping
Close work permit

CREW MEMBERS

Name Signature Name Signature

1. 6.

2. 7.

3. 8.

4. 9.

5. 10.

Note: Use the back side of the form if there are more than 10 crew members.

SMS\SSD\157\FRM
Revision 2
20 May 2022

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