Field Level Hazard Assessment

• FLHA #

• Date:

  Date

• Prepared by

• Company Name

• Location

• Site Contact

• Contact Number

• Client Safe Work Permit Number

• Description of task to be completed

• Muster Location

• Emergency Number

BASIC REQUIREMENTS

• Required PPE

  Select Hard hat Safety glasses High Visibility Gear Safety Boots Safety goggles Tyvek Rain gear Hearing protection Double hearing protection Personal fall arrest system Dust mask Respiratory Protection (half or full face) Rubber gloves Gloves Rain boots

  • Hard hat
  • Safety glasses
  • High Visibility Gear
  • Safety Boots
  • Safety goggles
  • Tyvek
  • Rain gear
  • Hearing protection
  • Double hearing protection
  • Personal fall arrest system
  • Dust mask
  • Respiratory Protection (half or full face)
  • Rubber gloves
  • Gloves
  • Rain boots

• Equipment

• Additional

HAZARDS

• Types of Hazards

  Select SAFETY HAZARDS WORKPLACE HAZARDS BIOLOGICAL HAZARDS PHYSICAL HAZARDS CHEMICAL HAZARDS ERGONOMIC HAZARDS OTHER HAZARDS

  • SAFETY HAZARDS
  • WORKPLACE HAZARDS
  • BIOLOGICAL HAZARDS
  • PHYSICAL HAZARDS
  • CHEMICAL HAZARDS
  • ERGONOMIC HAZARDS
  • OTHER HAZARDS

SAFETY HAZARD

• Driving

• Ensure proper licenses for the task, situational awareness

• Use spotter to back-up vehicles

• Report any issues to the Maintenance Department

• Electrical

• Hazardous Energy

• Follow Lockout/Tag Out procedure

• Extension cord usage

• Inspect extension cords for damage: Remove from service if damaged

• Ladders

• Inspect ladders to ensure they are in good condition

• Ensure proper tie-off if required, maintaining the 4:1 safety ratio

• Material Handling

• Use two person lift if over 55lbs and manual material handling is needed

• Only trained operators can use forklifts

• Tools

• Make sure tools are in good shape

• Tag and report any damaged tools

• Machinery

• Keep a safe distance

• Make sure guarding is not removed if present

• Slips/Trips/Falls

• Keep area clean

• Barricade as needed

• Apply salt/sand in icy conditions

• Other

• undefined

WORKPLACE HAZARDS

• Confined Space

• All workers trained in Confined Space Entry?

  Yes

  No

  N/A

• Stop work and report to Supervisor/Team Lead

• Working Alone

• All workers trained in

  Yes

  No

  N/A

• Yes

  No

  N/A

• Working at Heights

• All workers trained in working at heights?

  Yes

  No

  N/A

• Stop work and report to Supervisor/Team Lead

• Other

• undefined

BIOLOGICAL HAZARDS

• Sharps

• Report to site contact for correction/disposal

• Plants and insect exposure

• Ensure proper PPE is worn

• Bloodborne/bodily fluids risks

• Report to site contact for correction/disposal

• Fungus or mold

• Ensure proper PPE is worn

• Animal/bird droppings

• Ensure proper PPE is worn, clean up area

• Other

• undefined

PHYSICAL HAZARDS

• Noisy environment?

• Ensure appropriate hearing protection is used.

• Extreme temperatures (heat or cold)?

• Review Heat/Cold Stress Policy

• Ensure proper breaks and controls (additional water/layers)

• Inadequate lighting?

• Make sure there is proper task lighting

• Sources of radiation (signage at client site)?

• Ask about the client's Radiation Program/Emergency Response

• Other

• undefined

CHEMICAL HAZARDS

• Chemicals being used?

• List Chemicals

• SDS present

• List SDS

• Vapours/Fumes/Dust Present

• Use local exhaust if possible, use proper PPE

• If wearing tight-fitting respiratory protection, wearers MUST be clean shaven.

• Flammables or explosive materials

• Ensure proper bonding/grounding

• Asbestos present

• Report to site contact and supervisor/team lead

• Other

• undefined

ERGONOMIC HAZARDS

• Awkward body positioning for/during the task

• Review job task and consider job rotation

• Overexertion

• Review job task, consider job rotation and proper stretching

• Heavy/Awkward Load

• Use two-person carry or use a lifting device

• Hands not in the line of sight

• Review job task

• Repetitive motion

• Review job task and consider job rotation

• Working in a tight area

• Review job task and consider job rotation

• Working above the head

• Consider use of platform if possible or review job task

• Hand/Arm Vibration

• Review job task, consider job rotation and use of proper PPE

• Other

• undefined

OTHER HAZARDS

• Weather conditions

• Ensure proper clothing and break schedules

• Other workers in the area

• Advise workers of the tasks being done

• Barricade where possible

• Waste removal needed

• Use appropriate bins and review with client

• Material storage

• Make sure client has provided proper area

• Clean up after job completed

CHANGES IN CONDITIONS

• undefined

JOB COMPLETION

• Area cleaned up?

• Tools removed?

• Locks removed?

• Task completed?

• Incidents occurred while performing tasks?

ADDITIONAL COMMENTS

• undefined

• Ensure all workers have reviewed the document and sign off on the document

WORKER

• Name

  Sign

TEAM LEADER/SUPERVISOR

• Name

  Sign