Field Level Hazard Assessment

• Document No.

• Conducted on

  Date

INSTRUCTIONS: Identify potential hazard, prioritize and write the control for the hazard

GENERAL INFORMATION

• Task Location

• Task to be performed:

• PPE Inspected?

  Yes

  No

  N/A

• Muster Point Location

• People/ other worker in work area?

  Safe

  At Risk

  N/A

• Was SDS Reviewed, if needed

  Yes

  No

  N/A

Type of Hazard

• undefined

  Select Environmental Hazard. (Weather, Dust, Fumes, Noise, Spills, Workers in area) Ergonomic Hazards (Prolonged twisting, repetitive, bending motion, working in a tight area, lifting, etc) Access/ Egress Hazards (Aerial lift, scaffold, ladders, Slips and trips, confined or restricted spaces) Overhead Hazard (Overhead lines, hoisting or moving loads overhead, falling objects) Fall Protection and general safeguards (Hole coverings, harnesses, roof opentings, guardrails, proer safeguards on equipment) Rigging and Hoisting Hazards (Rigging plan, proper tools used, tools, slings and equipment inspected) Personal Limitations Hazards (properly trained, confussing instructions or none, first time doing task) Powered Mobile Equipment (High visibility clothing, traffic control, driving) Chemical or Biological Hazards (Air quality, ventilation, temp heat source, asbestos, SDS reviewed) Other (Cuts, Pinch Points, Tree Branches)

  • Environmental Hazard. (Weather, Dust, Fumes, Noise, Spills, Workers in area)
  • Ergonomic Hazards (Prolonged twisting, repetitive, bending motion, working in a tight area, lifting, etc)
  • Access/ Egress Hazards (Aerial lift, scaffold, ladders, Slips and trips, confined or restricted spaces)
  • Overhead Hazard (Overhead lines, hoisting or moving loads overhead, falling objects)
  • Fall Protection and general safeguards (Hole coverings, harnesses, roof opentings, guardrails, proer safeguards on equipment)
  • Rigging and Hoisting Hazards (Rigging plan, proper tools used, tools, slings and equipment inspected)
  • Personal Limitations Hazards (properly trained, confussing instructions or none, first time doing task)
  • Powered Mobile Equipment (High visibility clothing, traffic control, driving)
  • Chemical or Biological Hazards (Air quality, ventilation, temp heat source, asbestos, SDS reviewed)
  • Other (Cuts, Pinch Points, Tree Branches)

• Environmental Hazard: Is the Work Area Clean, Material Storage Identified, Dust, Mist, Fumes, Noise in Area, Extreme Temp, Weather Conditions, Spill Potential, Waste Properly Managed, Other Workers in Area, Ground Disturbance

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Ergonomic Hazard: Will you have Prolonged Twisting, Repetitive, Bending Motion. Working in Tight Areas. Lift too Heavy, Awkward to Lift

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Access and Egress Hazard: Are you using a Aerial Lift, Man Basket (inspected and Tagged), Scaffold (Inspected and Tagged), Ladders Tied Off, Slips, Trips, Hoisting (Tools and Equipment), Confined, Restricted Space Entry, Excavation

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Overhead Hazards: Is there Power Lines. Hoisting or Moving Loads Overhead, Falling Objects

• Yes

  No

  N/A

• What is at Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Fall Protection and General Safe Guards: Do Hole Coverings Identified, Tools, equipment and machinery have proper safeguards?

• What is at Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Yes

  No

  N/A

• Rigging and Hoisting Hazards: Do you have a Rigging Plan Availavble for Review, Proper Tools Used, Tools and Slings inspected, Equipment inspected

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Probability

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Personal Limitations Hazards: Are Procedure Not Available for Task, Confusing Instructions or No Instructions Available, No Training for Task or Tools to Be Used, First Time Performing the Task

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Powered Mobile Equipment Hazard: Do you have Powered mobile equipment including vehicles working at site, Powered Mobile equipment method to de-energize, High visibility clothing available, Traffic Control, Driving

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Chemical or Biological Hazard: Air Quality, Ventilation, Temporary Heat sources

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

• Yes

  No

  N/A

• Other Hazards: Could include sharp objects, cutting, pinch points, Slips, trips etc

• What is the Risk?

• How do we eliminate or reduce the risk?

• Severity

  1- Imminent Danger

  2- Serious

  3- Minor

  4- Not Applicable

• Probability

  A- Probable

  B- Resonably Probable

  C- Remote

  D- Extremely Remote

10.0 Has any equipment been locked out/tagged out or removed from service? Explain.

• 10.1 Locked, tagged or removed from service? explain if yes.

  Yes

  No

  N/A

• If yes explain

All workers must sign onto FLHA prior to work commencing. If any new workers show up onto site they must review this FLHA and sign on as we'll.

• Please list staff involved

  Select Shane Williams Carmela Amoroso Jamie Witham Jamie Rose Evan Klein Katey Falk Colin Allan-Fitterer Chris Burke Luke Sheedy Josh Innes Zac Sheedy Other

  • Shane Williams
  • Carmela Amoroso
  • Jamie Witham
  • Jamie Rose
  • Evan Klein
  • Katey Falk
  • Colin Allan-Fitterer
  • Chris Burke
  • Luke Sheedy
  • Josh Innes
  • Zac Sheedy
  • Other

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• Name

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• Name and Signature

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