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Contractor Name: Sub-Tier Contractor Name: Prepared By: Project: Location (e.g., building, area, etc.): Work Scope/Description: Excavate to a depth greater than five feet Specific Work Location(s): Name Contractor Contact Person(s): Alcoa SPA: Plant Emergency No.: Prejob Walkthrough Conducted: Yes 1. Hazardous Waste Operations 2. Confined Space 3. Hot Work 4. Roof Work 5. Fall Hazards (> 6 ft) 6. Excavation/Trenching 7. Scaffolds / Ladders 8. Aerial Lifts 9. Heavy Equipment 10. Lock and Tag 11. Site/Vehicle Traffic 12. 13. 14. 15. Electrical Hazards Asbestos Work Lead Work Hazardous Materials/MSDS 16. Respiratory Hazards No Yes No Yes No KNOWN OR POTENTIAL HAZARDS Reference 29 CFR 1910.120 ASP.653.3010 ASP.653.2308 ASP.653.2321 ASP.653.2001 ASP.653.2311 ASP.653.2302/2303 ASP.653.2205 ASP.653.2200 Series ASP.653.2315 ASP.653.1005/.2300 ASP.653.2309/.2310 ASP.653.3001 ASP.653.3005 ASP.653.2100/.3007 ASP.653.3008 17. Noise Exposure 18. Temperature Extremes 19. Hoisting & Rigging 20. Ergonomics: Repetitive Motion / Awkward Positions / Same Position (s) 21. Biological 22. Insects / Varmints / Vermin 23. Signs and Barricades 24. Location Specific Emergency Response Plan 25. Air Effluent Discharges 26. Water/Liquid Effluent Discharges 27. Fatality Prevention 28. Associated w/Significant Environmental Aspects? = Requires formal/special training = Requires a permit/form/report Primary/Phone # Project No.: Project Plant Location:
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