Field Level Hazard Assessment - October 2014

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

1. DIVISION

• Division

  Select 1. Water Treatment Plant 2. Sewage Treatment Plant 3. Incinerator Operation 4. Travel Time 5. Install 6. Commissioning 7. Rentals

  • 1. Water Treatment Plant
  • 2. Sewage Treatment Plant
  • 3. Incinerator Operation
  • 4. Travel Time
  • 5. Install
  • 6. Commissioning
  • 7. Rentals

2. TASK TO BE PERFORMED

• Task

  Select Site Check / Sampling / Maintenance Install / Move / Tear Out / Drain Field Shop Other

  • Site Check / Sampling / Maintenance
  • Install / Move / Tear Out / Drain Field
  • Shop
  • Other

3. HAZARDS

• 3.1 Biological / Chemical / Gas Hazards

  Safe

  At Risk

  N/A

• 3.2Confined Space Hazards

  Safe

  At Risk

  N/A

• 3.3 Electrical Hazards

  Safe

  At Risk

  N/A

• 3.4 Grinding / Cutting Hazards

  Safe

  At Risk

  N/A

• 3.5 Heavy / Awkward Lifting Hazards

  Safe

  At Risk

  N/A

• 3.6 Height Hazards

  Safe

  At Risk

  N/A

• 3.7 Ladder Hazards

  Safe

  At Risk

  N/A

• 3.8 Moving Equipment Hazards

  Safe

  At Risk

  N/A

• 3.9 New Worker / Task Hazards

  Safe

  At Risk

  N/A

• 3.10 Noise Hazards

  Safe

  At Risk

  N/A

• 3.11 Other Work In Area Hazards (Workers)

  Safe

  At Risk

  N/A

• 3.12 Pinch Point / Swing Path Hazards

  Safe

  At Risk

  N/A

• 3.13 Prolonged Twisting / Bending Hazards

  Safe

  At Risk

  N/A

• 3.14 Rotating Machinery Hazards

  Safe

  At Risk

  N/A

• 3.15 Sharp Object Hazards

  Safe

  At Risk

  N/A

• 3.16 Slip / Trip / Fall Hazards

  Safe

  At Risk

  N/A

• 3.17 Tool Hazards

  Safe

  At Risk

  N/A

• 3.18 Travel Hazards

  Safe

  At Risk

  N/A

• 3.19 Visibility Hazards

  Safe

  At Risk

  N/A

• 3.20 Weather / Temperature Hazards

  Safe

  At Risk

  N/A

• 3.21 Working Alone Hazards

  Safe

  At Risk

  N/A

• 3.22 Other Hazards

• Description & Response

• Take Pictures Of Hazards At Work Site So Control Measures Can Try To Be Made To Eliminate In Future

  Media

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.

• Lead Supervisor / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign

• Worker Name / Company

  Sign