Field Level Risk Assessment

• Audit Title

• Site
  Address

• Prepared by

  Sign

• Conducted on

  Date

• Weather Conditions

• PPE required onsite

• Muster Point Locations

• Are you working alone?

  Yes

  No

  N/A

• If you answer yes, carry cell phone on person and check in frequently with supervisor. Check out at the end of the day with them to ensure they know you have left the site for the day.

Possible Hazards

• Operating Mobile Equipment

  Yes

  No

  N/A

• Power Tools

  Yes

  No

  N/A

• Incompetent/ Uncertified Operation or Use

  Yes

  No

  N/A

• Falls from Heights

  Yes

  No

  N/A

• Powerlines/ Overhead Utilities

  Yes

  No

  N/A

• Rigging

  Yes

  No

  N/A

• Cranes and Hoists

  Yes

  No

  N/A

• Suspended Loads

  Yes

  No

  N/A

• Dropped Objects

  Yes

  No

  N/A

• Manual Lifting

  Yes

  No

  N/A

• Over Extending

  Yes

  No

  N/A

• Prolonged/ Extreme Bending

  Yes

  No

  N/A

• Prolonged/ Extreme Twisting

  Yes

  No

  N/A

• Repetitive Motion

  Yes

  No

  N/A

• Unstable Motions

  Yes

  No

  N/A

• Pinch Points

  Yes

  No

  N/A

• Vibration

  Yes

  No

  N/A

• Slips/Trips

  Yes

  No

  N/A

• Environmental Spills

  Yes

  No

  N/A

• Buried Utilities

  Yes

  No

  N/A

• Limited Access/ Egress

  Yes

  No

  N/A

• Electrical Systems

  Yes

  No

  N/A

• Illumination

  Yes

  No

  N/A

• Chemicals

  Yes

  No

  N/A

• Noise

  Yes

  No

  N/A

• Odour

  Yes

  No

  N/A

• Airborne Contaminents

  Yes

  No

  N/A

• Extreme Temperatures

  Yes

  No

  N/A

• Weather Conditions

  Yes

  No

  N/A

• Wildlife

  Yes

  No

  N/A

• Uneven Terrain

  Yes

  No

  N/A

• Congestion

  Yes

  No

  N/A

• Fire/ Explosion

  Yes

  No

  N/A

• Sensitive Environments

  Yes

  No

  N/A

• Energized Systems

  Yes

  No

  N/A

• Open Excavation

  Yes

  No

  N/A

• Other Workers in the Area

  Yes

  No

  N/A

• Confined Space

  Yes

  No

  N/A

• Material Storage

  Yes

  No

  N/A

• In the next section, list all of the hazards that may be present during the task. Above is a list of possible hazards to assist in the identification. Click yes to any that apply and list them in the next section.

Start of Shift

• Task

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

• Hazard

• Plans to eliminate or control

Throughout the shift

• Has anything changed on site? If so, what!

• What time did the condition change?

  Date

• Plans to eliminate or control

• Has anything changed on site? If so, what!

• What time did the condition change?

  Date

• Plans to eliminate or control

• Has anything changed on site? If so, what!

• What time did the condition change?

  Date

• Plans to eliminate or control

Other Workers in Work Area

• Worker#1

  Sign

• Worker#2

  Sign

• Worker#3

  Sign

• Worker#4

  Sign

• Worker#5

  Sign

• Worker#6

  Sign

• Worker#7

  Sign

• Worker#8

  Sign

• Worker#9

  Sign

• Worker#10

  Sign

Reviewed by:

• Instructors Signature

  Sign

• Instructors Signature

  Sign