Doppelmayr USA--Daily Risk Assessment (rev. 001)

• Conducted on

  Date

• Project Name

• Supervisor

• Project #

• Description of Activity

• Location of Task
  Address

• Prepared by

• INSTRUCTIONS
  
  1. Answer "Yes," "No," or "N/A" on the questions below. There are some fields that you need to enter the answer.
  2. Add photos and notes by clicking on the paperclip icon.
  3. To add a Corrective Action click on the paperclip icon then "Add Action," provide a description, assign to a member, set priority, and due date.
  4. Complete audit by providing digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.

EVALUATING YOUR WORK AREA:

• -Do you have the PPE needed for this task?

  Yes

  No

  N/A

• -Are you working around live systems?

  Yes

  No

  N/A

• -Are the required materials and tools provided?

  Yes

  No

  N/A

• -Does this task require special training?

  Yes

  No

  N/A

• -Have all tools/equipment been inspected before use?

  Yes

  No

  N/A

• -Is a Safety Data Sheet (SDS) review necessary for this task?

  Yes

  No

  N/A

• -Are work permits required for this task?

  Yes

  No

  N/A

• -Have Fall Prevention and Aerial Work procedures been reviewed?

  Yes

  No

  N/A

• -Fire Prevention/ Fire Hazards been discussed?

  Yes

  No

  N/A

• -Has a rigging inspection been performed?

  Yes

  No

  N/A

• -Has emergency equipment such as Fall Rescue Equipment, Ski Resort First Aid Personal Contact Information, and Phones been located?

  Yes

  No

  N/A

• -For congested project sites, has the work plan been coordinated with other crafts and/or contractors?

  Yes

  No

  N/A

• -Have Accident Procedures and Notification Plans been discussed?

  Yes

  No

  N/A

• -Have Helicopter Safety and Work Procedures been discussed?

  Yes

  No

  N/A

• Potential Hazards Checklist: Select all that apply

  Select Pinch points Manual lifting Falls from elevations Fire / Explosion Hazardous chemicals Particles in eyes Heat exhaustion/stress Mobile equipment Rigging work Steep terrain High noise levels Falling objects Critical lift (crane) Lockout/Tagout Working from ladders Elevated work Excavations Scaffolding Chemical spill Other

  • Pinch points
  • Manual lifting
  • Falls from elevations
  • Fire / Explosion
  • Hazardous chemicals
  • Particles in eyes
  • Heat exhaustion/stress
  • Mobile equipment
  • Rigging work
  • Steep terrain
  • High noise levels
  • Falling objects
  • Critical lift (crane)
  • Lockout/Tagout
  • Working from ladders
  • Elevated work
  • Excavations
  • Scaffolding
  • Chemical spill
  • Other

• Please specify

• Personal Protective Equipment: Select all that apply

  Select Hard hat Boots Safety glasses High visibility vests Gloves Fall protection Other Hearing protection Goggles

  • Hard hat
  • Boots
  • Safety glasses
  • High visibility vests
  • Gloves
  • Fall protection
  • Other
  • Hearing protection
  • Goggles

• Please specify

• Description of work to be performed:

• Hazards associated with each step:

• Actions needed to eliminate or control the hazard:

Work Crew Sign-Off:

• Click "Add Employee Signature" button for the sign off.

Employee Signature

• Employee Name & Signature

  Sign