Anonymous

FLRA

FIELD LEVEL RISK ASSESSMENT

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Use this Template

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Information

Type "FLRA" then location
Date
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List each person
Add signature

FLRA

Hazards
Mitigation
Check all permits required
- Confined Space
- Hot Work
- Digging
- Pipeline Breaking
- N/A
Are the proper permits available and in view?

Checklist

Tripping hazards removed or identified?
Proper PPE available and in good condition?
Equipment inspected?
Working properly?
Can and will continue to work safely?
Working alone?
Check in every 2 hours.

Anonymous

FLRA

FIELD LEVEL RISK ASSESSMENT

Use this Template

Print as PDF

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