FLRA

• FLRA No.

• FLRA

• PCS CORY

• Conducted on

  Date

• Prepared by David Heske

• Location
  Address

• Personnel

PERMITS /PLANS

• Hot Work / Cold Work

• Confined Space

• Demolition

• Ground Disturbance

• Excavation

• Lockout

• Critical Lift Plan

• Fall Protection plan

PERMIT IDENTIFIED HAZARD

• Hazard Detailed on Safe Work Permit

• Hazards on Critical Lift Permit

• Hazards on Electrical Permit

• Hazards Identified for Confined Space Entry

• Hazards on Confined Space Entry Permit

• Hazards on Hot/Cold Work Permit

• Hazards on Underground/Excavation Permit

• Hazards on Line Opening Permit

EMERGENCY EQUIPMENT

• Fire Extinguisher

• Eyewash/ Shower

• All Conditions Met

• Air Horn

• Extraction Equipment

• Permit Displayed

• Alarm Number.................5333

• Emergency Number

OVERHEAD OR WORKING AT HEIGHT HAZARD

• Harness Required / Appropriate Tie Off Identified

• Others Working Overhead / Below

• Falls From Heights

• Hoisting or Moving Loads Overhead / Around Task

• Use of Scaffolds

• Tasks Require You to Work Above Your Head

• Objects / Debris Falling From Above

• Overhead Power Lines

EQUIPMENT HAZARDS

• Operating Motor Vehicle / Heavy Equipment

• Contact With / Contact By

• Operating Power Equipment

• WORKING WITH:

• Saws

• Cutting Torch Equipment

• Hand Tools

• Grinders

• Welding Machines

• Cranes

WORK ENVIRONMENT HAZARDS

• Weather Conditions

• Temp conditions , precipitation etc.

• Waste Material Generated Performing Task

• Limited Access /Egress

• Foreign Bodies in Eyes

• Exposure to Energized Electrical Systems

• Lighting Levels too high / Too Low

• Position of Fingers / Hands - Pinch Points

• EXPOSURE TO:

• Chemicals

• Dust / Particulates

• Extreme Heat/Cold

• Reactive Chemicals

• Fogging of Monogoggles / Eye Protection

• Flammable Gases / Atmospheric Hazards

• Sharp Objects / Edges

• Noise

• Odors

• Steam

PERSONAL LIMITATIONS / HAZARDS

• Procedure Not Available for Task

• Confusing instructions

• No Training in Procedure /Task

• No Training in Tools to be Used

• First Time Performing This Task

• Mental Limitations / Distractions / Loss of Focus

• Not Physically Able to Perform Task

• Complacency

WELDING

• Shields

• Fire Blanket

• Fire Extinguisher

• Cylinder Secured / Secure Connections

• Cylinder Caps On

• Flashback Arrestors

• Combustibles Moved

• Sparks Contained

• Ground Clamp Within 18"

• Fire Watch / Spark Watch

PHYSICAL ENERGY HAZARDS

• Manual Lifting:

• Load too Heavy / Awkward to Lift

• Over Reaching

• Prolonged / Extreme Bending

• Repetitive Motions

• Unstable Positions

• Part(s) of Body in "Line of Fire"

• Hands Not in Line of Sight

• Working in Tight Clearances

• Physical Limitations - Need Assistance

• Uncontrolled Release of Energy / Force

• Fall Potential

PERSONAL PROTECTIVE EQUIPMENT

• Workgloves

• Chemical Gloves

• Kevlar Gloves

• Rain Gear

• Thermal Suits

• Rubber Boots

• Monogoggles /Faceshield

• Safety Glasses

• Respiratory Protection

• Hearing Protection

• Safety Harness / Lanyard / Lifeline

• Head Protection

• Steel-Toe Work Boots

• Hi Vis Vests

• Fire Retardant Wear

• OTHER (Preventative and Protective Measures)

• Is worker working alone?

  yes

  no

• If Yes, Explain /Note the procedure(s) in place.

• TASK(S)

• HAZARDS

• PLANS TO ELIMINATE / CONTROL RISK

• Supervisor

  Sign

• Worker

  Sign

• Worker

  Sign

• Worker

  Sign

• Worker

  Sign

• Worker

  Sign