Caliber Exteriors LTD Daily Field Level Hazard Assessment

• Site

• Muster point

• Conducted on

  Date

• Prepared by

SELECT ALL ENVIRONMENTAL HAZARDS THAT APPLY

• Material storage area identified

• Dust/mist/fumes

• Noise in area

• Extreme temperatures

• Spill potential

• Waste properly managed

• Excavation permit required

• Other workers/trades in area

• Weather conditions

• MSDS reviewed

SELECT ALL ERGONOMIC HAZARDS THAT APPLY

• Awkward body position

• Over extension

• Prolonged twisting/repetitive/bending motion

• Working in a tight area

• Loads too heavy/awkward to lift

• Hands not in line of sight

• Working above your head

SELECT ALL ACCESS/EGRESS HAZARDS THAT APPLY

• Aerial lift/man basket( inspected and tagged)

• Scaffolding (inspected and tagged)

• Ladders (tied off)

• Slips/trips

• Hoisting (tools/equipment)

• Evacuation (alarms/routes/phone numbers)

• Confined/restricted space entry required

SELECT ALL OVERHEAD HAZARDS THAT APPLY

• Barricades and signs in place

• Hole coverings identified

• Harness/lanyard inspected

• 100% tie-off with harness and anchor points identified

• Falling objects

• Powerlines

• Hoisting or moving loads overhead

SELECT ALL RIGGING AND HOISTING HAZARDS THAT APPLY

• Lift study required

• Proper tools used

• Tools/sling inspected

• Equipment inspected

• Others working overhead/below

• Critical lift permit

SELECT ALL ELECTRICAL HAZARDS THAT APPLY

• GFI test

• Lighting levels too low

• Working on/near energized equipment

• Electrical cords/tools condition

• Fire extinguisher

• Hot work or electrical permit required

PLEASE SELECT ALL PERSONAL LIMITATION HAZARDS THAT APPLY

• Procedure not available for task

• Confusing instructions

• No training for task or tools to be used

• First time performing the task

• IDENTIFY THE TASKS AND HAZARDS, THEN IDENTIFY THE PLANS TO ELIMINATE/CONTROL THEM

• Is there more than one worker from the crew on the job site for the day?

  Yes

  No

  N/A
Task

• Task :

• Hazard :

• Plan to eliminate/control :

• On a scale of 1 to 5 please select the value that best represents the severity of the task/hazards. 1 being very minor and 5 being potentially dangerous.

• ALL WORKERS/EMPLOYEES PRESENT ON THE JOB SITE MUST SIGN BELOW. BY SIGNING YOU AGREE THAT YOU UNDERSTAND ALL TASKS GIVEN, UNDERSTAND THE HAZARDS, THE CONTROL THERE-OFF, AND RISKS OF ALL ACTIONS TAKEN. ALSO YOU AGREE THAT YOU HAVE DONE AN INSPECTION OF ALL YOUR TOOLS/EQUIPMENT AND ALSO YOUR PERSONAL PROTECTION EQUIPMENT.

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JOB COMPLETION

• Was it a routine day with nobody having a close call or getting hurt?

  Yes

  No

  N/A

• Was the area cleaned up at the end of the job/shift?

  Yes

  No

  N/A

• What's the job site left in a clean presentable matter at the end of the shift with no hazards remaining?

  Yes

  No

  N/A

Foreperson's name and signature (sign upon reviewing completed assessment)

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Clients representative signature (review)

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