Field Level Hazard Assessment (FLHA)

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Activity

• Did you participate in the Daily Safety Meeting?

  Yes

  No

• The First Aid Kit is available

  Yes

  No

• New or young worker?

  Yes

  No

• Survival pack needed?

  Yes

  No

• Name of task

• Is this a non-routine task?

  Yes

  No

Contact/Caught/Fall

• Struck By

• Struck Against

• Cuts

• Impalement

• What will you do to mitigate these hazards?

Overexertion

• Lifting/Carrying

• Bend/Twist

• Push/Pull

• Repetition

• What will you do to mitigate these hazards?

Heavy Machinery

• Moving Equipment/Parts

• Pinch Points

• Line of Fire

• What will you do to mitigate these hazards?

Work Area

• Overhead Hazards

• Steep Terrain

• Elevated Work

• Wet Surface

• Uneven Surface

• Sharp Edges

• Access/Exits

• Flying Debris

• Remote/Isolation

• Confined Space

• What will you do to mitigate these hazards?

Environmental

• Heat/Cold

• Weather

• Wildlife

• Sunburn

• Fire Bans

• Danger Trees

• Drowning

• What will you do to mitigate these hazards?

Energy Sources

• Electrical

• Mechanical

• Under Pressure

• Energy Release

• Rotating Equipment

• Compressed Gasses

• What will you do to mitigate these hazards?

Housekeeping

• Areas Clean of Debris

• Trip Hazards

• Poor Design/Layout

• What will you do to mitigate these hazards?

Health

• Chemicals

• Dust, Fumes, Mists, Vapors

• Lighting Conditions

• Vibrations

• Loud Noise

• Fungi/Mold

• Animal Waste

• Heat Exhaustion

• What will yo do to mitigate these hazards?

Vehicle/Driving

• Gravel Road

• Blind Zones

• Narrow Roads/Bridges

• Slippery Road

• Recreational Traffic

• Towing/Trailer

• Equipment Failure

• Ground Workers

• What will you do to mitigate these hazards?

Other Hazards

• Fire/Explosion

• Radiation

• Floor Openings

• Excavation

• Other

• Other

• What will you do to mitigate these hazards?

Engineering Controls

• Elimination

• Isolation (Lockout Tagout)

• Barrier/Control Zone

• Equipment/Guard/Shield

• Substitution

• Ventilation

• Communication

Administrative Controls

• Permits

• Training

• Communication Plan

• Safe Operating Procedures (SOPs)

• Pre-Inspections

• Scheduling

PPE

• Hardhat

• Safety Glasses

• Gloves

• Hi-Vis

• Face Shields

• Safety Boots

• Respirator

• Hearing Protection

• Spill Kit

• Fall Protection

• Other

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