Field Level Job Hazard Assessment

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date

Potential Hazards

• Buried Pipelines

  Yes

  No

  N/A

• Buried power lines

  Yes

  No

  N/A

• Buried utilities

  Yes

  No

  N/A

• Chemicals (dust, gases, vapors)

  Yes

  No

  N/A

• Driving

  Yes

  No

  N/A

• Electricity

  Yes

  No

  N/A

• Energized equipment

  Yes

  No

  N/A

• Excavations/trenches

  Yes

  No

  N/A

• Gases/vapors/fumes

  Yes

  No

  N/A

• Heat (fire/burning)

  Yes

  No

  N/A

• Heat or cold stress

  Yes

  No

  N/A

• Lack of radio communication

  Yes

  No

  N/A

• Lifting heavy loads

  Yes

  No

  N/A

• Moving machinery

  Yes

  No

  N/A

• New worker

  Yes

  No

  N/A

• Noise

  Yes

  No

  N/A

• Overhead power lines

  Yes

  No

  N/A

• Rotating equipment

  Yes

  No

  N/A

• Sharp objects

  Yes

  No

  N/A

• Slippery conditions

  Yes

  No

  N/A

• Static electricity

  Yes

  No

  N/A

• Steep slopes

  Yes

  No

  N/A

• Traffic

  Yes

  No

  N/A

• Vibration

  Yes

  No

  N/A

• Water

  Yes

  No

  N/A

• Weather

  Yes

  No

  N/A

• Welding/cutting

  Yes

  No

  N/A

• Wildlife

  Yes

  No

  N/A

• Working alone

  Yes

  No

  N/A

• Working at heights

  Yes

  No

  N/A

Other hazards: Required hazard controls

• Additional lighting (e.g. Flashlight/trouble light)

  Yes

  No

  N/A

• Additional training

  Yes

  No

  N/A

• Barricades

  Yes

  No

  N/A

• Communication device

  Yes

  No

  N/A

• Confined space entry procedures

  Yes

  No

  N/A

• Check in/out procedures

  Yes

  No

  N/A

• Coveralls

  Yes

  No

  N/A

• CSA approved footwear

  Yes

  No

  N/A

• Emergency or rescue procedure

  Yes

  No

  N/A

• Eye protection

  Yes

  No

  N/A

• Fall arrest/travel restraint system

  Yes

  No

  N/A

• Fall protection

  Yes

  No

  N/A

• Fire extinguisher/fire blanket

  Yes

  No

  N/A

• First aid kit

  Yes

  No

  N/A

• First aid kit/epi pen

  Yes

  No

  N/A

• Gas monitors

  Yes

  No

  N/A

• Hard hat/helmet

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Hot work permit

  Yes

  No

  N/A

• JLG/Genie lifting device

  Yes

  No

  N/A

• Ladders for safe access and egress

  Yes

  No

  N/A

• Lockout tag procedure

  Yes

  No

  N/A

• Machine guarding

  Yes

  No

  N/A

• Mechanical ventilation

  Yes

  No

  N/A

• Other personal protection equipment

  Yes

  No

  N/A

• Overhead clearance established

  Yes

  No

  N/A

• Pedestrian barricades

  Yes

  No

  N/A

• Personal floatations device

  Yes

  No

  N/A

• Protective footwear

  Yes

  No

  N/A

• Safe work procedure

  Yes

  No

  N/A

• Safety glasses

  Yes

  No

  N/A

• Scaffolds (inspected and tagged)

  Yes

  No

  N/A

• Shovel/bucket

  Yes

  No

  N/A

• Signs

  Yes

  No

  N/A

• Spotter

  Yes

  No

  N/A

• Water

  Yes

  No

  N/A

• Welding shield

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Inspection by:

  Sign

• On site employee:

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