Accc - all - Field Level HAZARD ASSESSMENT

• Project Name

• Customer name:

Company: Absolute Completions

• Date

  Date

• Project name:

• Site location
  Address

• Work to be done?

SAFETY

• First Aider's identified and First Aid kit Available

  Yes

  No

  N/A

• Drinking water, Restroom facilities and Eye Wash Station available?

  Yes

  No

  N/A

• Muster location and Emergency procedures known?

  Yes

  No

  N/A

• MSDS available on site?

  Yes

  No

  N/A

EXISTING AREA HAZARDS

• Weather Conditions

  Safe

  At Risk

  N/A

• Extreme temperatures

  Safe

  At Risk

  N/A

• Noise

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Wet / Slippery Surfaces

  Safe

  At Risk

  N/A

• Work Area is Clean

  Safe

  At Risk

  N/A

• Others Working in Area

  Safe

  At Risk

  N/A

• Work being performed overhead? Potential Falling Objects?

  Safe

  At Risk

  N/A

• Craning / Hoisting operations in progress

  Safe

  At Risk

  N/A

• Power lines overhead?

  Safe

  At Risk

  N/A

• Floor openings covered and marked?

  Safe

  At Risk

  N/A

• Moving Vehicles / Equipment in the area

  Safe

  At Risk

  N/A

• Corrective action required by General Contractor or other trades?

• Photos of site conditions

  Media

Your working Conditions under your direct control

• Are you working at heights or above a hazard (your feet 9' above the ground)?

  Yes

  No

• Control: Fall protection plan and fall arrest training is required in order to proceed.

• Are you avoiding over extension, prolonged motion, awkward body position, heavy lifting, tight area?

  Yes

  No

  N/A

• Control: Remember to stretch and return to your normal body posture to avoid injury.

• Do you have only one emergency escape route? (working in Restricted / Confined Space Potential)

  Yes

  No

• Control: Ensure you have more then one escape route for emergencies, and if this is not possible you may need to have a confided entry permit and training.

• Working near energized / operating equipment?

  Yes

  No

• Control: ensure operator is aware you are in the area and ask for an orientation from competent worker responsible for energized / operating equipment. Lockout procedure may be needed.

• Tool Condition

  Safe

  At Risk

  N/A

• Equipment Condition

  Safe

  At Risk

  N/A

• PPE Condition

  Safe

  At Risk

  N/A

• Training Required

  Yes

  No

• Control: Ask for help and training from supervisor

• Working Alone

  Yes

  No

• Control: Working alone procedure must be used. Establish check in / call in frequency with supervisor and notify when completed.

• Dust/ Gas/ Fumes/ Mist

  Yes

  No

• Control: use exhaust / air exchange equipment and or respiratory protection

• Flammables/ Explosives in Area

  Safe

  At Risk

  N/A

• Control: reschedule work if possible or avoid sources of ignition.

• Chemical Handling

  Safe

  At Risk

  N/A

• Control: refer to MSDS for proper handling instructions, control measures and PPE required.

• Other site hazards

Hazard

• Task

• Hazard

• Control:

• Enter any corrective actions necessary

• Photos of Absolute hazards, if needed

  Media

JOB COMPLETION NOTES:

• Any hazards remain from your work?

  Yes

  No

• Control: ensure hazards are identified and barricaded to avoid injury / accident.

• Where there any near misses, first aid treatments, or incidents?

  Yes

  No

• Ensure these are recorded and reported to the Project Manager.

• Misc notes

• Photos of completed work if needed.

  Media

HAZARD REVIEW COMPLETED BY

• Email FLHA to safety@absolutecompletions.com and to the customer site supervisor once completed.

Worker

• Name:

  Sign