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SSC SAFETY & HEALTH ACTIVITY HAZARD ANALYSIS - page 1 / 3

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National Aeronautics and Space Administration

John C. Stennis Space Center Stennis Space Center, MS 39529-6000

SSC SAFETY & HEALTH ACTIVITY HAZARD ANALYSIS

(REQUIRED DAILY OR IF TASK CONDITIONS CHANGE)

COMPANY SUPERVISOR (Print & Sign Name) PRIME CONTRACTOR TASK ACTIVITY (List Basic Job Steps)

DATE CRAFT LOCATION OF WORK

POTENTIAL HAZARDS

A B C D E F

Electrocution/Shock Fall From Heights Work Overhead Noise Confined Space Entry Powered Industrial Truck

I J K

Pinch Points Flying Particles Heavy Duty Equipment

L M N

Severe Weather Welding Fume Welding Arc

Q

Silica Dust

R

Asbestos

S

Poor Work Position

T U V

Lifting: Manual/Mechanical Flammable Materials Chemicals (MSDS Review)

Y Z AA BB CC

Heat Stress/Cold Temperatures Compressed Air Slippery/Uneven Surfaces Motor Vehicle Slippery Surfaces

DD Other:

G H

Excavations/Trenches Hot Work

  • O

    Machinery- Rotate/Moving

P Lead Paint

W Rough/Sharp Material

X

Poor Lighting

ENTER

LETTER OF POTENTIAL HAZARD AND CORRECTIVE ACTIONS FOR EACH STEP

LETTER

EACH CORRECTIVE ACTION TAKEN TO ENSURE SAFETY

PERSON RESPONSIBLE

SAFETY CHECK LIST

(CHECK ALL APPLICABLE)

PERMITS REQUIRED

Hot Work Permit (228)688-3639

Confined Space Procedure & (228)688-1085

Y

N

PPE NEEDED Hard Hats

Steel Toe/Safety Shoes Hearing Protection Safety Glasses With Side Shields

Y

N

ELECTRICAL HAZARDS

Ground Fault Circuit Interrupters (GFCI) being used on all ext. cords

Lock Out/Tag Out Cords & Cables Safe For Use

Y

N

Excavation/Digging/Boring Permit (228)688-2961

Safe Atmospheric Verification Required

Utility Outage Request HazOp - Crane/Critical Lift Plan

FIRE PROTECTION PRECAUTIONS Fire Blankets

Welding Screens Flammables Removed Fire Extinguishers Available Trained Firewatcher Stationed

BARRICADES NEEDED Caution (Yellow)

Danger (Red) Hard Barridcade Flashing Lights Flag Man/Spotter Traffic Cones

Gloves Type:

Rubber Boots Fall Protection Equipment

Face Shield Coverall/Disposable Clothing Goggles (Chemical or Particulate) First Aid Kit Safety Shower Available Eye Wash Available (15 Min.) Flash Resistant Clothing Respiratory Protection

Supplied Air Respirator SCUBA OTHER Trench/Excavation Inspected MSDS Available On Site Water/Gatorade

Posted OSHA Posters Fall Protection Anchor Points

Extension Cords 3 Wire Type & Hard or Extra Hard Duty

Electrical Tools/Cords Inspected High Voltage Lines Identified Live Parts > 50 Volts Guarded

Other Other

WORK PLATFORMS FOR TASK Scaffold (Inspected and Tagged) JLG/Scissors Lift (Operator Cert.) Ladders (Inspected & Secured) Other

EMERGENCY PROCEDURES Security (228)688-3636 Posted Emergency/POC Listing

Lightening Precautions

Slings/Hoists Inspected Guard In Place Proper Tools

DAILY / PRE-WORK SAFETY MEETING

(CREW SIGN-IN ON PAGE 3)

TOPIC:

SSC-814 1/2010 (Informed Designer 4.2)

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