HSE WI01 F.L.R.A.

HSE WI01 Field Level Risk Assessment

• Project USB No.

• Site Name:

• Location
  Address

• Conducted on

  Date

• Audit conducted by:

• Supervisor Name:

• Other Employees or Sub-Contractors present:

• Describe the work activity to be performed:

HSE WI01 RISK ASSESSMENT

High and Medium Risk Activities

• Activities to be performed include sources of hazardous energy (lockout-tagout), working at height (incl. roof), elevated work platforms or mobile equipment, electrical work, hot work, line breaking, cranes, confined spaces, powered manual tools, sharp objects, chemical or biological exposures, hazardous materials, hazardous waste, demolition, or excavation?

  Safe

  At Risk

  N/A

Hazardous Materials: Compressed Gases, Flammable and Combustible Materials, Oxidizing Materials, Poisonous and Infectious Materials, Corrosive Materials, or Dangerously reactive materials.

• Hazardous Materials in use, transported, stored or disposed of?

  Yes

  No

  N/A

• Safety Data Sheets (SDS) readily available and reviewed?

  Yes

  No

  N/A

• Compressed gasses in use, transported, or stored? -secure, incompatibles segregated, fire-walls

  Yes

  No

  N/A

• Refrigerant use, transport, storage, removal? License / certification, data logs up-to-date, Safety Data Sheet, secure transport means

  Yes

  No

  N/A

• Any PCBs, Lead, Asbestos, Carbon Monoxide, Solvents, Welding fumes, Silica, radioactive containing materials that may be damaged or disturbed, etc.?

  Yes

  No

  N/A

• Waste(s) generated? hazardous --use only company approved hazwaste disposal companies, records, signed

  Yes

  No

  N/A

• Potential for spills / release of hazardous materials into environment (liquid, gaseous, solid)?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Hot Work, Line Breaking, Confined Spaces

• Hot work will be performed or is performed nearby? -permit

  Yes

  No

  N/A

• Hot work permit completed and controls implemented?

  Yes

  No

  N/A

• Ignition sources eliminated or controlled?

  Yes

  No

  N/A

• Line breaking? hazardous materials, high temperature, high pressure --permit?

  Yes

  No

  N/A

• Line breaking permit completed and controls implemented?

  Yes

  No

  N/A

• Any confined space entry required?

  Yes

  No

  N/A

• Permit required confined space has completed permit and implemented controls?

  Yes

  No

  N/A

• Non-permit required: hazards have been identified, risks assessed and controls implemented?

  Yes

  No

  N/A

Hand tools and equipment

• Powered hand tools (electric, pneumatic) to be used?

  Yes

  No

  N/A

• Completed pre-use inspection of tool?

  Yes

  No

  N/A

• Unsafe or damaged tools or equipment? (including missing or damaged guards)<br>

  Yes

  No

  N/A

• Appropriate tools and equipment for job? (e.g. grinding discs for cutting)<br>

  Yes

  No

  N/A

• Safe and compatible attachments used with tools and equipment? -guards in place-<br>

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Driving, Traffic and Interfaces with moving equipment

• Are you driving for work, working alongside or near traffic, or moving heavy equipment with no physical separation (barriers)?

  Yes

  No

  N/A

• Current driver license, vehicle preventive maintenance completed, no known vehicle issues?

  Yes

  No

  N/A

• Driving required in adverse conditions (rain, hail, snow, high wind, high / low sun, dark, wildlife, high mountain roads, high congestion, after extended shift, winter conditions, remote areas)?

  Yes

  No

  N/A

• Congestion in / near work area or road construction with changing conditions?

  Yes

  No

  N/A

• Working around operating trains, public transit, ATVs, helicopters/planes, boats / bodies of water?

  Yes

  No

  N/A

• Traffic control plan in place and implemented?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Emergency Response

• Work at height (incl. roof), elevated work platforms, electrical work, hot work, line breaking, cranes, excavation, or confined space entry taking place?

  Yes

  No

  N/A

• Fire extinguisher (fire blanket, fire watch)?

  Yes

  No

  N/A

• First Aid Kit and Attendant(s)?

  Yes

  No

  N/A

• Eye-wash station and/or safety shower?

  Yes

  No

  N/A

• Air horn?

  Yes

  No

  N/A

• Extraction equipment inspected, readily available, and rescuers competent?

  Yes

  No

  N/A

• Air monitoring devices?

  Yes

  No

  N/A

• Respirators readily available, appropriate, and competent person present?

  Yes

  No

  N/A

• Emergency rescue protocols understood and participants competent and current?

  Yes

  No

  N/A

• Alarm numbers available and displayed?

  Yes

  No

  N/A

• Communication devices readily available, functionality tested, communication protocol understood?

  Yes

  No

  N/A

• Permit conditions met and implemented?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Scaffolds

• Any scaffolds being built, standing or being removed?

  Yes

  No

  N/A

• Licensed engineer designed and licensed person erecting scaffold?

  Yes

  No

  N/A

• Scaffold Work Load Limit visible and not exceeded? (tools, stored materials, number of persons)<br>

  Yes

  No

  N/A

• Safe and complete scaffold (certified)?<br>

  Yes

  No

  N/A

• Inspection protocol for scaffold in place and implemented?<br>

  Yes

  No

  N/A

• Incompatible scaffold components?<br>

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Excavation

• Is any excavation being performed or in close vicinity?

  Yes

  No

  N/A

• Utilities / telecom called to verify location if digging, open areas, trenches, or disturbed ground?

  Yes

  No

  N/A

• Approved sub-contractor completed risk assessment, implemented controls and communicated to employees affected?

  Yes

  No

  N/A

• Design excavation and controls reviewed and signed off on?

  Yes

  No

  N/A

• Excavation equipment inspected, in good condition, operator trained and current and appropriate for task?

  Yes

  No

  N/A

• Employees working in vicinity prevented from entering area?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Cranes

• Cranes used or in / around work area?

  Yes

  No

  N/A

• Daily pre-use inspection completed and deficiencies corrected?

  Yes

  No

  N/A

• Operator certified and current?

  Yes

  No

  N/A

• Maintenance, testing and inspection records up-to-date and deficiencies corrected?

  Yes

  No

  N/A

• Any extensions (certified and weight load limit indicated) or slings (nylon, steel, rope) inspected, appropriately rigged and adequate for the weight load / task / environment and in good condition?

  Yes

  No

  N/A

• Work load limit posted on equipment and attachments?

  Yes

  No

  N/A

• Work load limit, including configuration considerations, not exceeded?

  Yes

  No

  N/A

• Load movement may occur out of sight or with limited visibility? spotter / signaling person required

  Yes

  No

  N/A

• Loads lifted over persons, close proximity to obstacles incl. overhead power lines? --not permitted

  Yes

  No

  N/A

• Crane lift study and permit completed and communicated?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Elevated Work Platforms and Mobile Equipment

• Elevated Work Platforms or Mobile Equipment (Manlift, scissorlift, fork-truck etc.) expected to be used or are you working in close vicinity of these?

  Yes

  No

  N/A

• Daily pre-use inspection completed and deficiencies corrected?

  Yes

  No

  N/A

• Operator certified / trained and current?

  Yes

  No

  N/A

• Fall protection systems in place and effective? anchor points

  Yes

  No

  N/A

• Equipment extensions (certified / weight load limit indicated) or slings (nylon, steel, rope) inspected, appropriately rigged and adequate for the weight load / task / environment and in good condition?

  Yes

  No

  N/A

• Access of equipment to work location evaluated? -struck by / struck against

  Yes

  No

  N/A

• Equipment movement in work area evaluated? -struck by / struck against

  Yes

  No

  N/A

• Load movement out of sight or with limited visibility? spotter / signaling person required

  Yes

  No

  N/A

• Are barricades and warning signs in place when working at height, on roof / near edges, hazardous processes, moving equipment, cranes, lifting equipment, etc.?

  Yes

  No

  N/A

• Roof-top access required? -roof risk assessment, permit

  Yes

  No

  N/A

• Any battery / electrical charging stations or compressed gas exchange required? -eyewash stations / safety showers if corrosives in place, proper secured storage and handling of compressed gas cylinders --do NOT roll--

  Yes

  No

  N/A

• People and moving equipment separated by barricades or similar? If not, use spotter

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Electrical working on or near

• Power Lines nearby and / or above? --contact utility company-

  Yes

  No

  N/A

• Working near exposed electrical conductors? -electrical work rubber gloves, liners with appropriate rating and tested within last 6 months, stored flat, etc.

  Yes

  No

  N/A

• Electrical work performed >50Volts?

  Yes

  No

  N/A

• GFCI tested?

  Yes

  No

  N/A

• Cords and equipment in good condition?

  Yes

  No

  N/A

• Extension cords used for temporary purposes only? -rated for intended use-

  Yes

  No

  N/A

• Unsafe electrical leads? (damaged, out of test date or untested)

  Yes

  No

  N/A

• Overloaded outlets?<br>

  Yes

  No

  N/A

• Electrical equipment near water or flammables or sources of ignition? -rating<br>

  Yes

  No

  N/A

• Bonding and grounding?<br>

  Yes

  No

  N/A

• Electrically classified area? -spark / explosion proof tools-

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Hazardous Energy

• Potential exposure to hazardous energy sources (electrical, pneumatic, hydraulic, kinetic, etc.) when working on equipment/machines/ or nearby?

  Yes

  No

  N/A

• Lockout-tagout kit adequate (personal, group) and readily available?

  Yes

  No

  N/A

• Any troubleshooting on energized equipment? -complete non-routine work risk assessment-

  Yes

  No

  N/A

• Verification of zero energy completed after lockout-tagour for all hazardous energy sources related to work activity?

  Yes

  No

  N/A

• Lockout-tagout start and end communicated to persons affected by LTV?

  Yes

  No

  N/A

• Lockout-tagout competent person / training current?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Working from heights

• Working from heights to be performed

  Yes

  No

  N/A

• Work performed at/above 1.2m (4') or at/within 1.8m (6') of roof edge/ledge?

  Yes

  No

  N/A

• Access needed to reach areas above guard rail, barrier? e.g. fire protection systems, lights, sensors in ceiling on equipment at height etc.?

  Yes

  No

  N/A

• Edge protection, barriers, guardrails?

  Yes

  No

  N/A

• Engineered and certified tie-off points (=5,000Kg)?

  Yes

  No

  N/A

• Wet, contaminated, slippery surfaces or handles/rails?

  Yes

  No

  N/A

• Adequate space to use scissor lift or similar device to access work at height?

  Yes

  No

  N/A

• Hazards from sharp edges, materials, equipment, facility infrastructures?

  Yes

  No

  N/A

• Situation requiring harness (inspected, retractable life line, anchor points, rescue plan)

  Yes

  No

  N/A

• Harness and equipment (pre-use inspected / external, labeled, complete, compatible parts (hooks, etc.), < 5years) and in good condition?

  Yes

  No

  N/A

• Fall prevention training and certification current for operators?

  Yes

  No

  N/A

• Ladders / steps used to access height? --inspected, tied off, materials appropriate, 4-1 angle, etc.

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Ergonomics

• Are ergonomic issues present? (poor body posture or exertion)

  Yes

  No

  N/A

• Any awkward body position or tight spaces to perform work?

  Yes

  No

  N/A

• Any prolonged bending or twisting?

  Yes

  No

  N/A

• Any manual handling of materials / awkward objects >10Kg (22lbs)?

  Yes

  No

  N/A

• Any kneeling, squatting or sitting on ground?

  Yes

  No

  N/A

• Any repetitive motion, especially in combination of excessive force?

  Yes

  No

  N/A

• Any work where hands / fingers not in line of sight?

  Yes

  No

  N/A

• Any work above head?

  Yes

  No

  N/A

• Any heavy or awkward lifting (>10Kg / 22lbs)?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Environmental Conditions

• Do environmental conditions exist? (heat, cold, storms)

  Yes

  No

  N/A

• Any high temperature and / or in combination with humidity? heat stress risk assessment?

  Yes

  No

  N/A

• Any cold temperature with potential for frostnip or frostbite?

  Yes

  No

  N/A

• Other adverse weather conditions? lightning, flood, hurricane, tornado, snowfall, hail storm, avalanche, mudslide

  Yes

  No

  N/A

Miscellaneous Conditions

• Do unusual conditions exist? (wet, sharp objects, moving parts, lighting, housekeeping, etc...)

  Yes

  No

  N/A

• Slippery / Wet / Uneven Surfaces or Stepping Over/Under Pipes / Facility Infrastructure?

  Yes

  No

  N/A

• Working in areas requiring access or use of using ladders, steps or stairs etc.? --inspected and tied off, appropriate material--

  Yes

  No

  N/A

• Any sharp edges or other cut hazards?

  Yes

  No

  N/A

• Rotating or moving machinery or parts (pulleys, belts, etc.)?

  Yes

  No

  N/A

• Grinding or cutting?

  Yes

  No

  N/A

• Working in electrically classified area? --explosion proof tools and processes must be implemented--

  Yes

  No

  N/A

• Low light/glare conditions or areas (in equipment)?

  Yes

  No

  N/A

• Overhead hazards from pipes / ducts / equipment, low or overhanging landings etc.?

  Yes

  No

  N/A

• Working above or under hazardous processes (high / low temperature, moving parts, hazardous materials, bodies of water, moving equipment, roads, etc.)?

  Yes

  No

  N/A

• Tools / Equipment storage / transport / use: falling from above or falling down below?

  Yes

  No

  N/A

• Ground or roof openings not barricaded?

  Yes

  No

  N/A

• Potential for entanglement / engulfment?

  Yes

  No

  N/A

• Combustible dust (wood, aluminum, grains etc.)?

  Yes

  No

  N/A

• Working alone?

  Yes

  No

  N/A

• Mechanical hazards?

  Yes

  No

  N/A

• High or Low pressure?

  Yes

  No

  N/A

• High or Low temperatures?

  Yes

  No

  N/A

• Appropriate hand tools (screw-drivers, wrenches, cutting tools, hammers, wire-strippers, etc.)?

  Yes

  No

  N/A

• Poor housekeeping?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Occupational Health

• Can environment cause short or long term health issues?

  Yes

  No

  N/A

• Any (hazardous material) exposure hazards absorption / inhalation / ingestion / contact?

  Yes

  No

  N/A

• Any sun, insect, rodent, bacteria, virus, mold, poisonous / wild animals, bodily fluid, sewage, hazards?

  Yes

  No

  N/A

• Radiation hazards?

  Yes

  No

  N/A

• Vibration hazards?

  Yes

  No

  N/A

• Noise hazards?

  Yes

  No

  N/A

• Splash hazards (chemical)?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Human Factors

• Are you mentally and physically prepared to do the task? (tired, sick, unsure, pressured, overworked, etc...)

  Yes

  No

  N/A

• Any confusion on how to perform the task at hand?

  Yes

  No

  N/A

• First time performing task or performing diagnostics / troubleshooting?

  Yes

  No

  N/A

• Returning to work after multiple days off?

  Yes

  No

  N/A

• Time pressured?

  Yes

  No

  N/A

• Excessive distractions?

  Yes

  No

  N/A

• Any lack of procedure / knowledge of process, equipment, tools on work activities to be performed?

  Yes

  No

  N/A

• Any tool / equipment you have not used before or have not been trained to use?

  Yes

  No

  N/A

• Any tool / PPE / equipment / Lock Tag Kit / Emergency Response Equipment that is not readily available / not in good condition / not appropriate size / not appropriate for the task?

  Yes

  No

  N/A

• Any hazards created and not well controlled by other people working in the area (non-company)?

  Yes

  No

  N/A

• Any continuous work hours in excess of 12 hours? -fatigue assessment-

  Yes

  No

  N/A

• Any other hazards?

  Yes

  No

  N/A

CONTROL MEASURES

• Any control measures required?

  Yes

  No

  N/A

• Lock Out Tag Out Kit?

  Yes

  No

  N/A

• Pre-use tool and/or equipment inspection completed and deficiencies corrected?

  Yes

  No

  N/A

• Risk Assessment & Procedure Review with people performing work?

  Yes

  No

  N/A

• Permits completed and communicated?

  Yes

  No

  N/A

• Competent People?

  Yes

  No

  N/A

• Supervision of Sub-contractors and/or Public?

  Yes

  No

  N/A

• Transport tools and appropriate storage of compressed gases and hazardous materials?

  Yes

  No

  N/A

• Spill kit?

  Yes

  No

  N/A

• Secondary containment?

  Yes

  No

  N/A

• Designated Work Areas?

  Yes

  No

  N/A

• Spotters, Signallers?

  Yes

  No

  N/A

• Lighting sources?

  Yes

  No

  N/A

• Signage?

  Yes

  No

  N/A

• Barricades?

  Yes

  No

  N/A

• Fire Extinguishers?

  Yes

  No

  N/A

• Fire Blankets?

  Yes

  No

  N/A

• Rescue Equipment?

  Yes

  No

  N/A

• UV, Insect Protection?

  Yes

  No

  N/A

• Gas Detection Devices?

  Yes

  No

  N/A

• Spark-proof or explosion proof tools?

  Yes

  No

  N/A

• Safety Data Sheet Review?

  Yes

  No

  N/A

• House Keeping?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Personal Protective Equipment

• Head protection? specify: bump cap, hard hat, other?

  Yes

  No

  N/A

• Eye and Face Protection? specify: safety glasses, safety goggles, face-shield with safety glasses, welding hood, other?

  Yes

  No

  N/A

• Foot protection? specify: safety boots, shoes, rubber/chemical resistant boots, other?

  Yes

  No

  N/A

• Additional PPE required?

  Yes

  No

  N/A

• Hand Protection? specify: workgloves, cutproof, electrical, chemical resistant, other?

  Yes

  No

  N/A

• Arm protection? specify: long sleeves, cut-proof sleeves, other?

  Yes

  No

  N/A

• Hearing protection? specify: ear plugs, ear muffs?

  Yes

  No

  N/A

• Fall protection gear? specify: harness, lanyard, SRL, other

  Yes

  No

  N/A

• Respiratory protection? specify: dust mask, half or full face-mask with cartridges, SCBA?

  Yes

  No

  N/A

• Electrical protection? specify: FR clothing layers, suit, gloves, face-shield, etc.?

  Yes

  No

  N/A

• Visibility related gear? specify high-visibility vest, arm/leg reflective bands, other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Protection Against the Elements

• Are there adverse weather conditions?

  Yes

  No

  N/A

• Adverse weather clothing? specify: raingear, cold-weather gear, etc.

  Yes

  No

  N/A

• Hot or cold temperature kit/gear?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

• Other?

  Yes

  No

  N/A

Verification

• Are all applicable work authorizations / permits appropriately completed, controls implemented, posted and reviewed with our company and sub-contractor employees involved in or affected by the work activities? -complete prior to starting work-

  Yes

  No

  N/A

• Are you performing the work with another employee participating or affected by the work activities?

  Yes

  No

  N/A

• Have you reviewed and discussed all the hazards identified, risks and agreed upon the appropriateness of the controls associated with the work activity? -contact supervisor if disagreement on controls- speak up if you feel not quite right about the approach!

  Yes

  No

  N/A

• Do you have all the appropriate tools, equipment, PPE, and control methods available, put in place and effectively implemented? -if not, address the issues or call supervisor if need supplies or clarification-

  Yes

  No

  N/A

• Are (sub)-contractor employees participating in, affected by, or performing this work activity?

  Yes

  No

  N/A

• A signed and dated (1 year or less) safety declaration is available for each sub-contractor involved in the work activity? --obtain via supervisor if not available-

  Yes

  No

  N/A

• The sub-contractor employees involved in the work have completed training in our company work-related HSE procedures? -complete prior to starting work activity-

  Yes

  No

  N/A

• The sub-contractor employees have taken and fully implemented appropriate measures to control the risks for their and our company employees? -must be done prior to starting work-

  Yes

  No

  N/A

• NO APPARENT (MED-HIGH) SAFETY RISK AT THIS TIME<br>(performing routine task at clean and safe workspace)

  Safe

  At Risk

  N/A

SIGN OFF

• Authorized Person: I have reviewed this FLRA and agree that it is a fair assessment of the job and I authorize this work to proceed.

• My Signature

  Sign