HSE FLRA

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

Environmental Hazards

• Solid Hazardous Waste to be generated

• Waste plan identified

• Liquid Spill Potential

• Gas Release potential

• Refrigerant Release potential

• High Temp / Cold Temp outdoor work

• Weather conditions

• Hole covering required

• Excavation permit required

• Other:

Ergonomics Hazards

• Awkward body position / tight space

• Excessive reaching

• Prolonged twisting bending motion

• Kneeling / Squatting or sitting on ground

• Lift too heavy / awkward lift

• Parts of body in line of fire

• Repetitive motion

• Hands not in line of sight

• Working above your head

• Other:

Access / Egress Hazards

• Working from Ladders (inspected)

• Slippery path

• Congested path / Housekeeping Issues

• Vehicle traffic area

• Hoisting (tools, equipment)

• Lighting Levels (low / flashing / bright)

• Evacuation complicated (alarms, routes)

• Other: