HSE FLRA

• CAB #:

• Project Name:

• 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

• Excavation permit required

• Hole covering 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:

Electrical Hazards

• Lockout required (complete JSA)

• GFI test

• Troubleshooting energized equipment

• Electrical cords condition

• Electrical tools condition

• Voltage (>50v)

• High Voltage >240V

• Near Exposed electrical conductors

• Electrically classified area (explosion proof)

• Other:

Working at Heights Hazards

• Scaffold (inspected and tagged)

• Ladders (inspected and tied off)

• Powered Mobile Equipment in use

• Roof top access (permit required?)

• Retractable Lifeline used

• Anchor Point

• Working within 15 ft / 3 m of edge

• Working above / near water

• Falling items

• Others working overhead / below

• Barricades and signs in place

• Other:

Rigging Practices Hazards

• Lift study required

• Critical lift permit

• Crane used (3rd party)

• Equipment inspection missing

• Slings required (rope / nylon / steel)

• Hoisting or moving loads overhead

• Temporary lift equipment (chainfall / winch)

• Out of sight load

• Multiple Signalers required

• Large or heavy load (>100 kg)

• Other:

Hazardous Work Permits

• Hot Work - flame

• Hot Work Sparks / excess heat

• Line Breaking – (hot / gas / chemical)

• Live Electrical work

• Confined Space - permit required

• Confined Space – non-permit required

• Other:

Personnel Hazards

• Procedure not available for task

• Confusing work / task instructions

• Not Trained to use tool

• First time performing task

• First time on site

• Distractions (noise, workers)

• Excess hours (>12)

• Is the worker working alone?

  No

  Yes

• Other:

Ensure PPE Requirements

• Hard hat

• Safety glasses

• Coveralls (nomex) (Arc Flash Rated)

• Gloves (kevlar / leather / electrical)

• CSA Boots – electrically rated

• Hearing Protection

• Arc Flash PPE

• Fall Prevention / Protection equipment

• Additional PPE required

TASKS: