Field Level Hazard Assessment

• Conducted on

  Date

• Person Conducting Assessment

• Location of Task
  Address

• Answer the following questions by selecting YES or NO
  
  You can add Media, Notes and Actions as necessary by clicking on the paper clip icon on the upper right corner of the question.
  - Upload images through the Add Media option.
  - Indicate notes through the Add Note option.
  - Assign to another user with a priority level and due date, and they will be notified in real-time via email, text (SMS) or push notification through the Add Action option.

Evaluating Your Work Area and Tasks

• Have you walked your the area?

  YES

  NO

• Has JHA been reviewed? (Attach picture)

  YES

  NO

• Do you have PPE available?

  YES

  NO

• Is drinking water available for employees?

  YES

  NO

• Are employees wearing proper and required PPE?

  YES

  NO

• Are employees wearing face shields when needed?

  YES

  NO

• Do prescription safety glasses have side shields?

  YES

  NO

• Firewatch onsite when performing hot work?

  YES

  NO

• Fire extinguishers accessible and inspected? Attach pictures

  YES

  NO

• Is there a fire extinguisher 25’ from fuel storage?

  YES

  NO

• Are combustible and flammable materials separated?

  YES

  NO

• Did you verified all containers are properly labeled?

  YES

  NO

• Spotters in place while moving material/equipment?

  YES

  NO

• Do all chains have appropriate and legible markings?

  YES

  NO

• Does operator have current certification card?

  YES

  NO

• Does equipment have proper company label? (ViCon logo)

  YES

  NO

• Are backup alarms working and audible?

  YES

  NO

• Operator wearing seatbelt while operating equipment?

  YES

  NO

• Have you verified all equipment in your area has being inspected? (Attach inspection report)

  YES

  NO

• CAZ in place for crane, aerial lifts?

  YES

  NO

• Are all barricades in placed where needed and in good condition?

  YES

  NO

• Do all barricades have proper signage?

  YES

  NO

• Are safety harnesses being worn properly?

  YES

  NO

• Is rigging being inspected daily?

  YES

  NO

• Is appropriate fall protection in place?

  YES

  NO

• Do employees have fall protection training?

  YES

  NO

• Are extension cords with damage, missing grounds, or exposed wires removed from service?

  YES

  NO

• Any impalement issues? (Attach pictures)

  YES

  NO

• Are ground fault circuit interrupters (GFCI) being used?

  YES

  NO

• Are hand tools inspected prior to use?

  YES

  NO

• Are guards in place on tools, such as saws/grinders?

  YES

  NO

• Is the right tool being used for the job?

  YES

  NO

• Are materials properly and neatly stacked in your area?

  YES

  NO

• Trash containers provided and emptied on a daily basis?

  YES

  NO

RISK ASSESSMENT

• RISK ASSESSMENT MATRIX

  

• Risk Assessment:
  1-5 is considered Low Risk: work may commence
  6-10 is considered Moderate Risk: Action needs to be taken to eliminate or minimize risk prior to work commencing
  11-15 is considered High Risk: Immediate action must be taken to eliminate or minimize risk down to a Low to Moderate Risk with controls in place prior to work commencing. If this is not possible then job task cannot commence
  16-25 is considered Extreme Risk: Job shutdown, urgent action must be taken to eliminate or minimize risk down to a Low or Moderate Risk with controls in place prior to work commencing. If this is not possible then the job task cannot commence
  
  Click the ADD button to add a TASK
  Step 1 - Identify the Task
  Step 2 - Identify the Hazards
  Step 3 - Conduct Risk Assessment by using the Matrix above
  Step 4 - Actions to Eliminate / Control Hazard

• Add TASK and identify the HAZARDS

Task

• Step 1 Identify Task

• Step 2 Identify Hazards

• Step 3 Conduct Risk Assessment

• Low Risk: work may commence

  

• Moderate Risk: Action needs to be taken to eliminate or minimize risk prior to work commencing

  

• High Risk: Immediate action must be taken to eliminate or minimize risk down to a Low to Moderate Risk with controls in place prior to work commencing. If this is not possible then job task cannot commence

  

• Extreme Risk: Job shutdown, urgent action must be taken to eliminate or minimize risk down to a Low or Moderate Risk with controls in place prior to work commencing. If this is not possible then the job task cannot commence

  

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Click ADD to SIGN

• Worker Full Name and Signature

  Sign