Title Page
-
Thankyou for filling out your daily jobsite field level hazard assessment. Please answer all questions truthfully. You have the right to refuse unsafe work.
-
Client
-
What is the task / tasks being performed?
-
Location
-
Conducted on
-
Prepared by
-
FLHA #
Site Conditions
-
Safe entry / exit
-
Excavations (holes)
-
Slip or trip hazards
-
Cranes, powerlines, or other overhead hazards
-
Handrails, guardrails, balconies & floor openings
-
Noise
-
Lighting / visibility
-
Housekeeping / waste
-
Material storage / flamables
-
Heaters
-
Electrical outlets / panels
-
Ventilation / hazardous fumes
-
Scheduling
-
Are you working alone?
- I'm here with my team
- There are other people on site that know I'm here
- I'm working alone
- I'm working alone and no one knows where I am
-
Who is checking in on you?
-
Workers on site
-
Enter your teamates full names
-
Stop what you are doing and contact a supervisor immediately
Emergency Perparedness
-
Is emergency procedure posted and current?
-
Are emergency first aid kits fully stocked, visible and accessible?
-
Are workers aware of what to do in an emergency?
-
Are fire extinguishers inspected, tagged with current months inspection and in good working order?
-
Is there need for a work at heights or confined space rescue plan?
Tools, Equipment & PPE (Personal Protective Equipment)
-
Ladders, planks & benches
-
Scaffolding
-
Stilts
-
Hand tools
-
Power tools
-
Cords
-
PPE required on this site
- Steel toe boots
- Hard hat
- High vis vest
- Safety glasses / face shield
- Face mask
- Hearing protection
-
Masks / respirators required?
-
Clothing
Documentation
-
Training / orientation
-
Evacuation plan reviewed
-
Is there a first aider on site?
-
Enter name of the first aider
-
First aid kit location
-
Muster point location
-
Safety handbook
-
GHS (Globally Harmonized System of Classification and Labeling of Chemicals)
-
SDS (Safety Data Sheets)
-
ERN (Emergency Response Numbers)
-
Is a fall arrest plan required?
-
Identify any other hazards on the site
Click Add to sign
-
Enter your full name and sign
