Field Leadership Record - Details
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Date :
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Area Visited :
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Area Notified :
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Topic (LA&CCO) :
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Persons observed (optional) :
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Task / SOP/ WI Observed
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Type of FL :
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Question 1 - What are the things that can kill you? Question 2 - What are the critical controls that keep you safe? Question 3 - How do you know the critical controls are working effectively?
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Team Members :
Behaviours
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Positive Behaviours / Conditions Observed
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At Risk Behaviours / Conditions Observed:
CAT A -Reactions of People, CAT B - Positions of people, CAT C - PPE,
CAT D - Tools & Equipment, CAT E - Procedures, CAT F - Work Area -
1.
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Category A - Reactions of people
- A1 Adjusting PPE
- A2 Rearranging job
- A3 Stopping job
- A4 Attaching to
- A5 Changing Lockouts
- A6 Not fitness for work
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Potential Consequence
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Category B - Positions of People
- B1 Striking against
- B2 Struck by
- B3 Caught Between
- B4 Temp. Extremes
- B5 Inhaling
- B6 Absorbing
- B7 Swallowing
- B8 Posture, Lifting, Twisting
- B9 Over-Extension
- B10 Falling
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Potential Consequence
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Category C - PPE
- C1 Eyes & Face
- C2 Ears
- C3 Head
- C4 Hands & Arms
- C5 Feet & Legs
- C6 Respiratory
- C7 Trunk
- C8 Other
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Potential Consequence
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Category D - Tools & Equipment
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Potential Consequence
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CAT E - Procedures, CAT F - Work Area
- E1 Procedures inadequate for the job
- E2 Procedure not known or understood
- E3 Procedure not followed
- F1 Poor Housekeeping
- F2 Inadequate Storage
- F3 Unclean
- F4 Not Barricaded
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Potential Consequence
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2.
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Category A - Reactions of people
- A1 Adjusting PPE
- A2 Rearranging job
- A3 Stopping job
- A4 Attaching to
- A5 Changing Lockouts
- A6 Not fitness for work
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Potential Consequence
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Category B - Positions of People
- B1 Striking against
- B2 Struck by
- B3 Caught Between
- B4 Temp. Extremes
- B5 Inhaling
- B6 Absorbing
- B7 Swallowing
- B8 Posture, Lifting, Twisting
- B9 Over-Extension
- B10 Falling
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Potential Consequence
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Category C - PPE
- C1 Eyes & Face
- C2 Ears
- C3 Head
- C4 Hands & Arms
- C5 Feet & Legs
- C6 Respiratory
- C7 Trunk
- C8 Other
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Potential Consequence
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Category D - Tools & Equipment
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Potential Consequence
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CAT E - Procedures, CAT F - Work Area
- E1 Procedures inadequate for the job
- E2 Procedure not known or understood
- E3 Procedure not followed
- F1 Poor Housekeeping
- F2 Inadequate Storage
- F3 Unclean
- F4 Not Barricaded
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Potential Consequence
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3.
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Category A - Reactions of people
- A1 Adjusting PPE
- A2 Rearranging job
- A3 Stopping job
- A4 Attaching to
- A5 Changing Lockouts
- A6 Not fitness for work
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Potential Consequence
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Category B - Positions of People
- B1 Striking against
- B2 Struck by
- B3 Caught Between
- B4 Temp. Extremes
- B5 Inhaling
- B6 Absorbing
- B7 Swallowing
- B8 Posture, Lifting, Twisting
- B9 Over-Extension
- B10 Falling
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Potential Consequence
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Category C - PPE
- C1 Eyes & Face
- C2 Ears
- C3 Head
- C4 Hands & Arms
- C5 Feet & Legs
- C6 Respiratory
- C7 Trunk
- C8 Other
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Potential Consequence
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Category D - Tools & Equipment
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Potential Consequence
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CAT E - Procedures, CAT F - Work Area
- E1 Procedures inadequate for the job
- E2 Procedure not known or understood
- E3 Procedure not followed
- F1 Poor Housekeeping
- F2 Inadequate Storage
- F3 Unclean
- F4 Not Barricaded
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Potential Consequence
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4.
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Category A - Reactions of people
- A1 Adjusting PPE
- A2 Rearranging job
- A3 Stopping job
- A4 Attaching to
- A5 Changing Lockouts
- A6 Not fitness for work
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Potential Consequence
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Category B - Positions of People
- B1 Striking against
- B2 Struck by
- B3 Caught Between
- B4 Temp. Extremes
- B5 Inhaling
- B6 Absorbing
- B7 Swallowing
- B8 Posture, Lifting, Twisting
- B9 Over-Extension
- B10 Falling
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Potential Consequence
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Category C - PPE
- C1 Eyes & Face
- C2 Ears
- C3 Head
- C4 Hands & Arms
- C5 Feet & Legs
- C6 Respiratory
- C7 Trunk
- C8 Other
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Potential Consequence
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Category D - Tools & Equipment
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Potential Consequence
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CAT E - Procedures, CAT F - Work Area
- E1 Procedures inadequate for the job
- E2 Procedure not known or understood
- E3 Procedure not followed
- F1 Poor Housekeeping
- F2 Inadequate Storage
- F3 Unclean
- F4 Not Barricaded
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Potential Consequence
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5.
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Category A - Reactions of people
- A1 Adjusting PPE
- A2 Rearranging job
- A3 Stopping job
- A4 Attaching to
- A5 Changing Lockouts
- A6 Not fitness for work
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Potential Consequence
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Category B - Positions of People
- B1 Striking against
- B2 Struck by
- B3 Caught Between
- B4 Temp. Extremes
- B5 Inhaling
- B6 Absorbing
- B7 Swallowing
- B8 Posture, Lifting, Twisting
- B9 Over-Extension
- B10 Falling
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Potential Consequence
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Category C - PPE
- C1 Eyes & Face
- C2 Ears
- C3 Head
- C4 Hands & Arms
- C5 Feet & Legs
- C6 Respiratory
- C7 Trunk
- C8 Other
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Potential Consequence
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Category D - Tools & Equipment
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Potential Consequence
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CAT E - Procedures, CAT F - Work Area
- E1 Procedures inadequate for the job
- E2 Procedure not known or understood
- E3 Procedure not followed
- F1 Poor Housekeeping
- F2 Inadequate Storage
- F3 Unclean
- F4 Not Barricaded
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Potential Consequence
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6.
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Category A - Reactions of people
- A1 Adjusting PPE
- A2 Rearranging job
- A3 Stopping job
- A4 Attaching to
- A5 Changing Lockouts
- A6 Not fitness for work
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Potential Consequence
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Category B - Positions of People
- B1 Striking against
- B2 Struck by
- B3 Caught Between
- B4 Temp. Extremes
- B5 Inhaling
- B6 Absorbing
- B7 Swallowing
- B8 Posture, Lifting, Twisting
- B9 Over-Extension
- B10 Falling
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Potential Consequence
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Category C - PPE
- C1 Eyes & Face
- C2 Ears
- C3 Head
- C4 Hands & Arms
- C5 Feet & Legs
- C6 Respiratory
- C7 Trunk
- C8 Other
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Potential Consequence
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Category D - Tools & Equipment
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Potential Consequence
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CAT E - Procedures, CAT F - Work Area
- E1 Procedures inadequate for the job
- E2 Procedure not known or understood
- E3 Procedure not followed
- F1 Poor Housekeeping
- F2 Inadequate Storage
- F3 Unclean
- F4 Not Barricaded
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Potential Consequence
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7.
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Category A - Reactions of people
- A1 Adjusting PPE
- A2 Rearranging job
- A3 Stopping job
- A4 Attaching to
- A5 Changing Lockouts
- A6 Not fitness for work
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Potential Consequence
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Category B - Positions of People
- B1 Striking against
- B2 Struck by
- B3 Caught Between
- B4 Temp. Extremes
- B5 Inhaling
- B6 Absorbing
- B7 Swallowing
- B8 Posture, Lifting, Twisting
- B9 Over-Extension
- B10 Falling
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Potential Consequence
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Category C - PPE
- C1 Eyes & Face
- C2 Ears
- C3 Head
- C4 Hands & Arms
- C5 Feet & Legs
- C6 Respiratory
- C7 Trunk
- C8 Other
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Potential Consequence
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Category D - Tools & Equipment
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Potential Consequence
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CAT E - Procedures, CAT F - Work Area
- E1 Procedures inadequate for the job
- E2 Procedure not known or understood
- E3 Procedure not followed
- F1 Poor Housekeeping
- F2 Inadequate Storage
- F3 Unclean
- F4 Not Barricaded
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Potential Consequence
General / Actions
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General Comments
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Task Risk Assessment completed :
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Comments :
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Action items - By Who?, By When?
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1.
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By who?
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By when?
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2.
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By who?
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By when?
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3.
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By who?
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By when?
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4.
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By who?
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By when?
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5.
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By who?
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By when?
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6.
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By who?
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By when?
Add Photos as required;
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Photo 1:
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Photo Details;
Team Members name and signatures :
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Team Member 1 :
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Team Member 2 :
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Team Member 3 :
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Team Member 4 :
