Field Level Hazard Assessment Template

• Job Site

• Location
  Address

• Full Name of Construction Worker

• Work Area

• Date of Assessment

  Date

Field Level Hazard Assessment

• Briefly describe your tasks for the shift.

Before Commencing Work

• List the hazards in your work area by tapping ADD HAZARD.

HAZARD

• Type of Hazard

  Select Access/ Egress Rigging & Hoisting Overhead Electrical Mechanical Physical Environmental Chemical Biological Ergonomic Others

  • Access/ Egress
  • Rigging & Hoisting
  • Overhead
  • Electrical
  • Mechanical
  • Physical
  • Environmental
  • Chemical
  • Biological
  • Ergonomic
  • Others

• Specify the hazard.

• Take photos of the hazard in your work area.

  Media

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

During Task Execution

• 

• Were changes made to your current tasks?

  Yes

  No

• List all changes made to your current tasks by tapping ADD TASK UPDATE.

TASK UPDATE

• Briefly describe the task update.

• Type of hazard associated with the task update.

  Select Access/ Egress Rigging & Hoisting Overhead Electrical Mechanical Physical Environmental Chemical Biological Ergonomic Others

  • Access/ Egress
  • Rigging & Hoisting
  • Overhead
  • Electrical
  • Mechanical
  • Physical
  • Environmental
  • Chemical
  • Biological
  • Ergonomic
  • Others

• Specify the hazard.

• Take photos of the hazard in your work area.

  Media

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

• Were you given new tasks during your shift?

  Yes

  No

• List all new tasks to be done during your shift by tapping ADD NEW TASK.

NEW TASK

• Briefly describe the new task.

• Type of hazard associated with the new task.

  Select Access/ Egress Rigging & Hoisting Overhead Electrical Mechanical Physical Environmental Chemical Biological Ergonomic Others

  • Access/ Egress
  • Rigging & Hoisting
  • Overhead
  • Electrical
  • Mechanical
  • Physical
  • Environmental
  • Chemical
  • Biological
  • Ergonomic
  • Others

• Specify the hazard.

• Take photos of the hazard in your work area.

  Media

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

• Did new workers come on site?

  Yes

  No

• Identify potential hazards by tapping ADD POTENTIAL HAZARD.

POTENTIAL HAZARD

• Type of Hazard

  Select Access/ Egress Rigging & Hoisting Overhead Electrical Mechanical Physical Environmental Chemical Biological Ergonomic Others

  • Access/ Egress
  • Rigging & Hoisting
  • Overhead
  • Electrical
  • Mechanical
  • Physical
  • Environmental
  • Chemical
  • Biological
  • Ergonomic
  • Others

• Specify the potential hazard.

• Take photos of the hazard in your work area.

  Media

• How did you control the potential hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

• Did job site conditions change?

  Yes

  No

• List all changes in job site condition by tapping ADD JOB SITE UPDATE.

JOB SITE UPDATE

• Briefly describe the change in job site condition.

• Type of hazard associated with the change in job site condition.

  Select Access/ Egress Rigging & Hoisting Overhead Electrical Mechanical Physical Environmental Chemical Biological Ergonomic Others

  • Access/ Egress
  • Rigging & Hoisting
  • Overhead
  • Electrical
  • Mechanical
  • Physical
  • Environmental
  • Chemical
  • Biological
  • Ergonomic
  • Others

• Specify the hazard.

• Take photos of the hazard in your work area.

  Media

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

Completion

• I cleaned up my work area at the end of my shift and my tools and equipment have been inspected.

• Full Name and Signature of Construction Worker

  Sign