Field Level Risk Assessment Template

• Job Site

• Location
  Address

• Full Name of Construction Manager

• Date of Assessment

  Date

Field Level Risk Assessment

Pre-work Checklist

• Did you review the Project/ Contract Risk Assessment?

  Yes

  No

  N/A

• Are all PPE to perform the task available?

  Yes

  No

  N/A

• Have tools, equipment and vehicles been inspected prior to use?

  Yes

  No

  N/A

• Did you attend the required training for this project?

  Yes

  No

  N/A

• Have all required permits been completed? (e.g. municipal, ground disturbance, confined space, hot work, environmental, etc.)

  Yes

  No

  N/A

• Are lock-out requirements in place?

  Yes

  No

  N/A

• Is a job-specific Emergency Response Plan in place?

  Yes

  No

  N/A

• Is there a rescue plan in place? (e.g. confined place, working at heights, etc.)

  Yes

  No

  N/A

Work Description

• Briefly describe your tasks for the shift.

• List the hazards in your work area by tapping ADD HAZARD.

HAZARD

• Type of Hazard

  Select Access/ Egress Rigging & Hoisting Overhead Electrical Mechanical Physical Environmental Chemical Biological Ergonomic Others

  • Access/ Egress
  • Rigging & Hoisting
  • Overhead
  • Electrical
  • Mechanical
  • Physical
  • Environmental
  • Chemical
  • Biological
  • Ergonomic
  • Others

• Specify the hazard.

• Take photos of the hazard in your work area.

  Media

Risk Assessment

• How likely is a person to be injured if exposed to the hazard? (Likelihood)

  1—Highly Unlikely

  2—Unlikely

  3—Likely

  4—Very Likely

• How bad would the most severe injury be if exposed to the hazard? (Consequences)

  1—Negligible Injuries

  2—Minor Injuries

  3—Major Injuries

  4—Fatality

• Risk rating (multiply the likelihood and consequence):

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

During Task Execution

• 

• Were changes made to your current tasks?

  Yes

  No

• List all changes made to your current tasks by tapping ADD TASK UPDATE.

TASK UPDATE

• Briefly discuss the task update.

• Specify the hazard associated with the task update.

• Take photos of the hazard in your work area.

  Media

Risk Assessment

• How likely is a person to be injured if exposed to the hazard? (Likelihood)

  1—Highly Unlikely

  2—Unlikely

  3—Likely

  4—Very Likely

• How bad would the most severe injury be if exposed to the hazard? (Consequences)

  1—Negligible Injuries

  2—Minor Injuries

  3—Major Injuries

  4—Fatality

• Risk rating (multiply the likelihood and consequence):

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

• Were you given new tasks throughout the day?

  Yes

  No

• List all new tasks to be done throughout the day by tapping ADD NEW TASK.

NEW TASK

• Briefly discuss the new task.

• Specify the hazard associated with the new task.

• Take photos of the hazard in your work area.

  Media

Risk Assessment

• How likely is a person to be injured if exposed to the hazard? (Likelihood)

  1—Highly Unlikely

  2—Unlikely

  3—Likely

  4—Very Likely

• How bad would the most severe injury be if exposed to the hazard? (Consequences)

  1—Negligible Injuries

  2—Minor Injuries

  3—Major Injuries

  4—Fatality

• Risk rating (multiply the likelihood and consequence):

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

• Did new workers come on site?

  Yes

  No

• Identify potential hazards by tapping ADD POTENTIAL HAZARD.

POTENTIAL HAZARD

• Specify the potential hazard associated with new workers on site.

• Take photos of the hazard in your work area.

  Media

Risk Assessment

• How likely is a person to be injured if exposed to the hazard? (Likelihood)

  1—Highly Unlikely

  2—Unlikely

  3—Likely

  4—Very Likely

• How bad would the most severe injury be if exposed to the hazard? (Consequences)

  1—Negligible Injuries

  2—Minor Injuries

  3—Major Injuries

  4—Fatality

• Risk rating (multiply the likelihood and consequence):

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

• Did job site conditions change?

  Yes

  No

• List all changes in job site condition by tapping ADD JOB SITE UPDATE.

JOB SITE UPDATE

• Briefly discuss the change in job site condition.

• Specify the hazard associated with the change in job site condition.

• Take photos of the hazard in your work area.

  Media

Risk Assessment

• How likely is a person to be injured if exposed to the hazard? (Likelihood)

  1—Highly Unlikely

  2—Unlikely

  3—Likely

  4—Very Likely

• How bad would the most severe injury be if exposed to the hazard? (Consequences)

  1—Negligible Injuries

  2—Minor Injuries

  3—Major Injuries

  4—Fatality

• Risk rating (multiply the likelihood and consequence):

• How did you control the hazard?

  Physically removed it

  Replaced it

  Isolated people from it

  Changed the way I worked

  Protected myself with PPE

Completion

• The job site has been secured. All safety controls/ overnight work signage are in place.

• Full Name and Signature of Construction Worker

  Sign