Yes
No
呼吸保护高压作业脚手架/升降台
Excavating/Trenching:
Yes
No
Work Permits:
Yes
No
Asbestos and/or Lead:
Yes
No
开挖/沟壕
工作许可
石棉/铅
Public Exposure
Yes
No
Working over Water:
Yes
No
Hazardous Materials/Waste:
Confined Space(s):
Yes
No
Line Breaking:
Yes
No
Health Hazards:
Yes
No
受限空间管线破坏健康危害
Respiratory Protection:
Yes
No
High Voltage Work:
Yes
பைடு நூலகம்No
Scaffolding/Aerial Lifts:
Project:项目
Contractor:
承包商：
JSANo.
编号:
Page第页
Of
共
Descriptionof Work:工作描述:
Falls from Elevation:
Yes
No
Underground Utilities:
Yes
No
Energized Systems/LOTO:
Yes
No
高空坠落地下设施带电系统/锁定标定
Required Actions to Eliminate or Control the Hazard降低或控制风险的措施
REVIEW SIGNATURES AND DATE
Prepared by准备人：
Date日期
Contractor Superintendent/Engineer承包商主管/工程师
Date日期
Contractor Safety Representative承包商安全人员
Date日期
Yes
No
公众暴露水上作业危险材料/废物
Hot Work:
Yes
No
Cranes/Rigging:
Yes
No
Other ( specified)
Yes
No
热加工
吊装/索具
其它(具体描述)
Sequence of Basic Job Steps工作步骤
Hazards Associated with Each Step相关风险