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Ground Effects Work Site Hazard Assessment
Ground Effects Work Site Hazard Assessment
Jonathan Richards

Ground Effects Work Site Hazard Assessment

Work Site Hazard Assessment must be filled out before the beginning of every job.

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Free Ground Effects Work Site Hazard Assessment Checklist

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Title Page

  • Conducted on

  • Prepared by

  • Location

  • Site Supervisor:

  • Project Number :

  • Other Attendees:

  • * If hazard exists (at-risk) fill in the notes with the description of the hazard and corrective action plan.
    * Priority (status) based on seriousness of hazard
    # 1 Immediate Danger - Possible Death - Project Shutdown # 2 Serious Hazard - Major Injury - Significant Project Disruption # 3 Moderate Hazard - Minor Injury - Some Project Disruption # 4 Minor Hazard – First Aid or Less - Low Impact on Project

  • Waste Disposal/ Housekeeping

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Material Storage/ Handling

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Confined Space Entry

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Traffic Control/ Restrictions

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Overhead Hazards

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Underground Hazards

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Flammables (Fire/Explosion)

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Hazardous Chemicals

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Dangerous Pressure & Vacuum

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Lifting and Carrying

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Cables/ Ropes/ Chains/ Slings

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Vehicle/Machine Condition

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Gas ( Toxic or Nontoxic)

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Electrical Wiring & Guards

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Hot Work

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Ergonomics

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Wildlife and Insects

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Pinch Points

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Personnel Training/Knowledge/ Skills

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Working From Heights or Excavations

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Weather Conditions

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Lighting/ Noise/ Vibration

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • TDG

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Emergency Preparedness

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Mobile Equipment

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Ventilation

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Trips, Slips and Falls

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Permits

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Protection for the Public

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Crane Usage

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Pipe Handling

  • Priority of the hazard

  • Description of hazard:

  • Corrective Action Implemented:

  • Follow-up Signature

  • Due Date

  • Manager's Signature (required):

PPE Required

  • Hard Hat

  • Safety Glasses

  • Hearing Protection

  • Fire Resistant Coveralls

  • Gloves

  • Respiratory Protection

  • Steel Toed Boots

  • Fall Protection

  • Splash Resistant Clothing

  • Face Shield

Monitoring

  • H2S Alive

  • % LEL

  • CO

  • O3

  • O2

  • Ozone

  • Chlorine

Safety Equipment

  • Fire Extinguisher

  • Eye Wash

  • First Aid Kit

  • Horn or Alarm

  • Signs

  • Barricades

  • SDS (WHMIS)

  • Cell Phone

Emergency Contacts

  • Project Manager:

  • Contact #:

  • Safety Officer:

  • Contact #:

  • Muster Area:

  • Emergency # if different from 911:

  • Onsite First Aid Attendant(s):

Ground Effects Work Site Hazard Assessment
Jonathan Richards

Ground Effects Work Site Hazard Assessment

Work Site Hazard Assessment must be filled out before the beginning of every job.

Use this Template
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.

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