Title Page

  • Conducted on

  • Prepared by

  • Location
  • Foreman Signature

  • Foreman Contact Information

  • Customer / Department Signature

ENSURE PPE REQUIREMENTS

  • Complete FLRA card PRIOR to start of task or change in condition. Review the listed hazards with crew at the site, ONLY check the items which apply to the job. Document the hazards and identify the level of risk and controls for each.

Ensure PPE Requirements

  • Hard hat

  • Safety glasses

  • Coveralls (nomex) (Arc Flash Rated)

  • Gloves (kevlar / leather / electrical)

  • CSA Boots – electrically rated

  • Hearing Protection

  • Arc Flash PPE

  • Fall Prevention / Protection equipment

  • Additional PPE required

List of Hazards. Tick the ones that apply and answer the series of questions below it.

  • Environmental Hazards

  • Solid Non-Haz Waste to be generated

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Hazardous Waste to be generated

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Waste plan identified

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Liquid Spill Potential

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Gas Release Potential

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Refrigerant Release potential

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • High Temp / Cold Temp outdoor work

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Weather conditions

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Excavation permit required

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Hole covering required

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Other

  • Other Environmental Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Ergonomics Hazards

  • Awkward body position / tight space

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Excessive reaching

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Prolonged twisting bending motion

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Kneeling / Squatting or sitting on ground

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Lift too heavy / awkward lift

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Parts of body in line of fire

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Repetitive motion

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Hands not in line of sight

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Working above your head

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Other

  • Other Ergonomics Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Access / Egress Hazards

  • Working from Ladders (inspected)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Slippery path

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Congested path / Housekeeping Issues

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Vehicle traffic area

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Hoisting (tools, equipment)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Lighting Levels (low/ flashing / bright)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Evacuation complicated (alarms, routes)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Other

  • Other Access/Egress Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Electrical Hazards

  • Lockout required (complete JSA)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • GFI test

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Troubleshooting energized equipment

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Electrical cords condition

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Electrical tools condition

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Voltage (>50v)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • High Voltage >240V

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Near Exposed electrical conductors

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Electrically classified area (explosion proof)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Other

  • Other Electrical Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Working at Heights Hazards

  • Scaffold (inspected and tagged)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Ladders (inspected and tied off)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Powered Mobile Equipment in use

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Roof top access (permit required?)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Retractable Lifeline used

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Anchor Point

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Working within 15 ft / 3 m of edge

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Working above / near water

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Falling items

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Others working overhead / below

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Barricades and signs in place

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Other

  • Other Working at Heights Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Rigging Practices Hazards

  • Lift study required

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Critical lift permit

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Crane used (3rd party)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Equipment inspection missing

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Slings required (rope / nylon / steel)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Hoisting or moving loads overhead

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Temporary lift equipment (chainfall / winch)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Out of sight load

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Multiple Signalers required

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Large or heavy load (>100 kg)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Other

  • Other Rigging Practices Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Hazardous Work Permits

  • Hot Work - flame

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Hot Work Sparks / excess heat

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Line Breaking – (hot / gas / chemical)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Live Electrical work

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Confined Space - permit required

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Confined Space – non-permit required

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Other

  • Other Work Permits Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Personnel Hazards

  • Procedure not available for task

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Confusing work / task instructions

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Not Trained to use tool

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • First time performing task

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • First time on site

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Distractions (noise, workers)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

  • Excess hours (>12)

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

Worker

  • Is the worker working alone?

  • Other

  • Other Personnel Hazard
  • Describe Hazard

Risk Assessment BEFORE Control Measures/Methods

  • Probability / Likelihood BEFORE Control Measures/Methods

  • Severity / Consequence BEFORE Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment BEFORE Controls?

  • Control Measures/Methods to mitigate risks. Click on the paperclip icon, create an action, and assign it to who should action the Control.

Risk Assessment AFTER Control Measures/Methods

  • Probability / Likelihood AFTER Control Measures/Methods

  • Severity / Consequence AFTER Control Measures/Methods

  • Screen Shot 2018-05-17 at 7.02.45 am.png
  • Risk Assessment level AFTER Controls?

  • Please STOP inspection and notify your supervisor about this hazard.

OTHER QUESTIONS

OTHER QUESTIONS

  • Are there hazards remaining?

  • Are permits closed out?

  • Area cleaned at end of job/shift?

  • Warning ribbon removed?

Names

  • Worker

  • Name
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.