Field Level Hazard Assessment

• Site conducted

  Select

• Conducted on

  Date

• Client Name

• Description of work to be performed

  Gravel/Sand Delivery

  Contaminate Hauling

  Rip Rap Delivery

  On-site work

  Equipment moving (Lowboying)

• Location (LSD)

• Prepared by

• Location
  Address

• Are there overhead powerlines?

• What is the probability of contacting one?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of contacting one?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for overhead powerlines?

  Select Keep a safe distance away (7m safe) Use a spotter when spreading near lines Spread under lines with a clam/belly dump

  • Keep a safe distance away (7m safe)
  • Use a spotter when spreading near lines
  • Spread under lines with a clam/belly dump

• Is the ground soft or uneven?

• What is the probability of a roll-over?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of a roll-over due to soft ground?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for soft/uneven ground?

  Select Move to level or stable ground before dumping

  • Move to level or stable ground before dumping

• Are there high noise levels on site?

• What is the probability of needing hearing protection?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What is the severity of the noise levels?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for noise levels?

  Select Wear hearing protection (i.e. ear plugs, ear muffs)

  • Wear hearing protection (i.e. ear plugs, ear muffs)

• Are there flammable sources/H2S on site?

• What is the probability of an incident?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of an incident?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for flammable sources/H2S on site?

  Select Be escorted by someone with a personal monitor Use a wind sock to know wind direction

  • Be escorted by someone with a personal monitor
  • Use a wind sock to know wind direction

• Are there steep slopes?

• What is the probability of roll-over?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of a incident from the steep slope?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for steep slopes?

  Select Don't spread on side hills Keep boxes lower while spreading up or down hills Chain up when slippery Use tow cat

  • Don't spread on side hills
  • Keep boxes lower while spreading up or down hills
  • Chain up when slippery
  • Use tow cat

• Is the area congested or are there multiple operations taking place?

• What is the probability of an incident in the congested area?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of an incident in the congested area?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for multiple operations on site?

  Use a spotter when backing up

• Is there other vehicle traffic?

• What is the probability of having an incident with the other vehicle traffic?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of an incident with other vehicle traffic?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for other vehicle traffic?

  Select Use correct radio channel to communicate with other vehicles on the road and call all kms Be courteous- know who has the right of way Give appropriate room for all oncoming traffic Obey all posted speed limits Chain up when required

  • Use correct radio channel to communicate with other vehicles on the road and call all kms
  • Be courteous- know who has the right of way
  • Give appropriate room for all oncoming traffic
  • Obey all posted speed limits
  • Chain up when required

• Is there a possibility for slips, trips and falls?

• What would be the probability of a slip, trip or fall?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of a slip, trip or fall?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for slips, trips & falls?

  Select 3 point contact Wear appropriate footwear Be aware of conditions/surroundings- look around before getting off/on equipment

  • 3 point contact
  • Wear appropriate footwear
  • Be aware of conditions/surroundings- look around before getting off/on equipment

• Are there pinch points?

• What is the probability of an incident from a pinch point?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of an incident with a pinch point?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for pinch points?

  Select Keep all limbs away from pinch point zones Never stand behind load when dumping Wear all appropriate PPE (i.e. gloves, hardhat etc.)

  • Keep all limbs away from pinch point zones
  • Never stand behind load when dumping
  • Wear all appropriate PPE (i.e. gloves, hardhat etc.)

• Are there visibility/weather hazards?

• What is the probability of an incident due to visibility?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of an incident due to visibility?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for visibility/weather hazards?

  Select Keep windows/mirrors clean Ensure all lights are working Use a spotter When in doubt, get out and check surroundings Drive according to road conditions Chain up for road conditions Give yourself enough time to avoid rushing

  • Keep windows/mirrors clean
  • Ensure all lights are working
  • Use a spotter
  • When in doubt, get out and check surroundings
  • Drive according to road conditions
  • Chain up for road conditions
  • Give yourself enough time to avoid rushing

• Is smoking a hazard on this site?

• What would be the probability of having an incident due to smoking?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of having an incident due to smoking?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for smoking on site?

  Use designated smoking areas

• Is hoisting/lifting a hazard?

• What is the probability of having an incident with hoisting/lifting?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of an incident with hoisting/lifting?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for hoisting/lifting?

  Select Never get under/behind suspended load Block box if necessary Wear PPE as required Look up for overhead powerlines

  • Never get under/behind suspended load
  • Block box if necessary
  • Wear PPE as required
  • Look up for overhead powerlines

• Is wildlife a hazard?

• What is the probability of having an incident with wildlife?

  Extremely Remote

  Remote

  Reasonably Probable

  Probable

• What would be the severity of having an incident with wildlife?

  OK (N/A)

  Minor

  Serious

  Imminent Danger

• What is the control(s) for wildlife?

  Select Drive according to speed limit Drive according to road conditions Communicate with other crew members when getting out in a remote area via 2-way radio

  • Drive according to speed limit
  • Drive according to road conditions
  • Communicate with other crew members when getting out in a remote area via 2-way radio

• What are the emergency phone numbers for the site?

• What is the location of the muster point?

• Have the identified hazards been discussed and reviewed with all T&L Employees/Subcontractors working on this job?

  Yes

  No

  N/A

All T&L Employees and Subcontractors must sign below:

• Employee/Subcontractor Name

  Sign

• Employee/Subcontractor Name

  Sign

• Employee/Subcontractor Name

  Sign

• Employee/Subcontractor Name

  Sign

• Employee/Subcontractor Name

  Sign

• Employee/Subcontractor Name

  Sign

• Site Supervisor Signature

  Sign