Field Level Risk Assessment

• Project No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• ACTIVITY DESCRIPTION:

DESCRIPTION OF WORKS

• 1.1. Division

  OPERATIONS

  INSPECTION

  MAINTENANCE

  INSTILATION

• 1.2. Tasks

HAZARDS

• 2.1. Heights

  Safe

  At Risk

  N/A

• 2.2. Equipment

  Safe

  At Risk

  N/A

• 2.3. Power Lines

  Safe

  At Risk

  N/A

• 2.4. Electricity

  Safe

  At Risk

  N/A

• 2.5. Sharp Objects

  Safe

  At Risk

  N/A

• 2.6. Slippery / Wet Surfaces

  Safe

  At Risk

  N/A

• 2.7. Gasses

  Safe

  At Risk

  N/A

• 2.8. Underground Utilities

  Safe

  At Risk

  N/A

• 2.9. Overhead Obstructions

  Safe

  At Risk

  N/A

• 2.10. Hazardous Substances

  Safe

  At Risk

  N/A

• 2.11. Ignition Sources

  Safe

  At Risk

  N/A

• 2.12. Manual Handling

  Safe

  At Risk

  N/A

• 2.13. High Pressure

  Safe

  At Risk

  N/A

• 2.14. Lifting Equipment

  Safe

  At Risk

  N/A

• 2.15. Rotating Machinery

  Safe

  At Risk

  N/A

• 2.16. Ground Openings

  Safe

  At Risk

  N/A

• 2.17. Entanglement

  Safe

  At Risk

  N/A

• 2.18. High Voltage

  Safe

  At Risk

  N/A

• 2.19. Confined Space

  Safe

  At Risk

  N/A

• 2.20. Weather Conditions

  Safe

  At Risk

  N/A

• 2.21. Welding

  Safe

  At Risk

  N/A

• 2.22. Grinding / Cutting

  Safe

  At Risk

  N/A

• 2.23. Spills

  Safe

  At Risk

  N/A

• 2.24. Other Hazards

CONTROL MEASURES

• 3.1. Lock Out Tag Out

  Yes

  No

  N/A

• 3.2. Spotters

  Yes

  No

  N/A

• 3.3. Lighting

  Yes

  No

  N/A

• 3.4. Respiratory Protection

  Yes

  No

  N/A

• 3.6. Signage

  Yes

  No

  N/A

• 3.7. Barricades

  Yes

  No

  N/A

• 3.8. Fall Arrest

  Yes

  No

  N/A

• 3.9 Extinguishers

  Yes

  No

  N/A

• 3.10 Guards

  Yes

  No

  N/A

• 3.11. Fire Blankets

  Yes

  No

  N/A

• 3.12. Procedures

  Yes

  No

  N/A

• 3.14. Competent People

  Yes

  No

  N/A

• 3.15 Locating Equipment

  Yes

  No

  N/A

• 3.16. UV Protection

  Yes

  No

  N/A

• 3.17. Gas Detection

  Yes

  No

  N/A

• 3.18. Designated Work Areas

  Yes

  No

  N/A

• 3.19. Supervision of Public

  Yes

  No

  N/A

• 3.19. Material Data Sheet Review

  Yes

  No

  N/A

• 3.20. House Keeping

  Yes

  No

  N/A

• 3.21. Other Control Measures

SIGN OFF

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• Team Member

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• Team Member

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• Team Member

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• Authorized Person: I have reviewed this FLRA and agree that it is a fair assessment of the job and I authorize this work to proceed.

• Team Leader

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