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Job Safety Analysis [ISA] <br /> Aerial Lift Usage <br /> (cherry picker, bucket truck) <br /> Site Information Last Updated: March 24,2009 <br /> ACTIVITY DATE <br /> SITE NAME DEPARTMENT <br /> CONTRACTOR Wayne Perry, Inc.18281 Commonwealth Avenue I Buena Park,CA 90621 !(714)826-0352 <br /> TEAM MEMBERS SIGN OFF&APPROVAL(print name and sign) <br /> 1 3 5 <br /> 2 4 6 <br /> Pre-Task Requirements <br /> PPE Requirements: (please indicate by box) Environmental Requirements:(tick box) <br /> 10 Hard Hat ® Eye Protection ❑ Spark Containment ❑ Air Pollution <br /> • Safety Boots ❑ Hearing Protection ❑ Extinguishers ❑ Storm Water Pollution <br /> ® Reflective Clothing ❑ Dust Masks ❑ Safety Harness El Noise Pollution <br /> Gloves Other: ❑ Body Belt © Soil Erosion <br /> Other: Other: ❑ Lanyard ❑ Work Zone Control <br /> Notes: Appropriate Personal Protective Equipment(PPE)must be worn Required Training: <br /> at all times. At a minimum,this shall include high visibility clothing, 1.Operation of aerial lift <br /> safety helmet(hard hat)and safety footwear. Fall protection equipment 2. Electrical safety <br /> (e,g,safety harness)is required to be used for working at height 3. Fall protection <br /> operations when the hazard cannot be eliminated by engineering controls. <br /> Task Steps <br /> STEP ACTIVITY HAZARDS RISK CONTROL MEASURE NOTES <br /> 1 Conduct/Review 1. Not noticing hazards in the work 1. Alwaysconduct site hazard 1. All persons who perform Work at <br /> Site Hazard area which could be mitigated. evaluation prior to task.Before Height shall be trained in the <br /> Evaluations beginning work,check for hazards associated with Work at <br /> previously unnoticed hazards. Height and any equipment to be <br /> Make sure there is a stable base used while performing Work at <br /> for the lift. Avoid soft earth;loose Height. <br /> gravel or sand that might cause 2 Work shall not be permitted <br /> the lift to shift while being used. within 10 feet of an electric <br /> power circuit. <br /> Page 1 of 3 <br />