1_N3B_Task_Specific_Briefing_Form.doc
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- Solicitation number
- RFP-0000297
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N3B Task Specific Briefing Form
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Environmental Remediation Task Specific Briefing
IWD No.______________________________ Project Title:__________________________________
Other Reference (e.g., RWP, SOP)______________________ _________________________ Date:
New Task Briefing Date: _________________ Refresher Briefing Date_____________ Notifications (ER Ops/EOC)__________________ Person-In-Charge, PIC (Name)________________________________Alternate PIC(s) or POC’s___________________________________
What are the critical steps or phases of this activity?
How can we make a mistake at this point?
What is the worst thing that can go wrong?
What controls, preventive measures, and bounding conditions are needed?
What work permits are required and how will we meet their requirements?
What are the handoffs and coordination requirements among workers and multiple PICs?
Are there hold-points including those that require sign-offs?
What are the pause work responsibilities and expectations (e.g. for unanticipated conditions or hazards)?
How would we respond to alarms and emergencies?
Are there lessons learned from previous similar work?
Is other information needed to perform this activity in a safe, secure, and environmentally responsible manner?
Does everyone agree to the work tasks/steps, hazards, and controls Hazards; Issues; Concerns and commit to follow them?
| Tasks at Hand Specific to Plan of the Day, POD – Y/N |
| Hazards; Issues; Concerns |
| Controls (Specific PPE, Engineering Controls, Administrative Controls, Other ) |
Conditions / Specific Training / Notes:
Perform work per the requirements specified in the project Radiological Work Permit (RWP) and practices by project RCTs as applicable. Verified YES / NA
By signing below, I agree to the following:
· I understand the work, the hazards, and the controls.
· I agree to follow the work steps and implement the controls as written.
· I agree to stop work when conditions or hazards change or when I encounter unexpected conditions during the execution of work, or when work cannot be performed as written, or instructions become unclear during execution.
I confirm that I am authorized, qualified and,fit to perform the work.
| Print Name |
| Signature |
| Z # |
| Employer |
| Date |
Briefing Conducted (Name)_____________________ _Signature:____________________________Z#: Date:
Briefing Conducted (Name)_____________________ _Signature____________________________Z#: Date:
RFP-0000297
N3B Task Specific Briefing 01 2019
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