JR FLHA+Template

• FLHA #

• Company Name:

• Site Name:

• FLHA Date &Time:

  Date

• Prepared by

• Location
  Address

• Worksite Representative Name & Phone Number

• PO#(if applicable)

• Describe the task(s) being performed

• If working alone, explain check-in procedure:

• Location of First Aid supplies:

• Emergency Muster Location:

• See It.....What could go wrong?

• Evaluate It.....How bad could it be?

• Control It.....What can I do to fix it?

• Worksite Comments and Observations:

Hazards

• Hazards to Consider- check off all that apply. If you check off a hazard, please choose the Risk Rating and Probability Frequency for that hazard

Hazards-Physical Work Area

• Housekeeping

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Slip/trip/fall potential

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Ground surface condition

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Blocked exits and walkways

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Open excavation

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Confined/restricted space

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Was a confined space permit obtained?

  Yes

  No

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Cramped/tight work spaces

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Improper ventillation

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Hot work

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Vehicle/pedestrian traffic

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Working at heights (10ft or more)

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Do you have a fall arrest plan?

  Yes

  No

• Do you have a fall arrest rescue plan?

  Yes

  No

• Do you have proper fall arrest equipment?

  Yes

  No

• Was the fall arrest equipment inspected?

  Yes

  No

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Falling Objects

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards-Electrical

• Working on/near energized equipment

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Working on/near electricity

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Powerlines overhead/underground

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards- Equipment

• Incorrect tools/equipment

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Defective tools/equipment

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Equipment without proper guards

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Ladder use

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Did you inspect the ladder?

  Yes

  No

• Were any defects found during inspection?

  Yes

  No

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Scaffolding

• Risk Rating

  Yes

  No

  N/A

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Are the platforms stable?

  Yes

  No

  N/A

• Does the scaffold have any defects?

  Yes

  No

  N/A

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Training/education Insect repellant Sunscreen Hydration Frequent Micro Breaks

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Training/education
  • Insect repellant
  • Sunscreen
  • Hydration
  • Frequent Micro Breaks

• Scaffolding

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Did you inspect the scaffolding?

  Yes

  No

• Were any defects found during inspection?

  Yes

  No

• Are the scaffold platforms stable?

  Yes

  No

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Loads being hoisted or moving

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Critical lifts

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards-Ergonomic

• Awkward body positioning

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Overextension

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Vibration

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Repetitive Motion

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Forceful pushing/pulling

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Awkward grip/load carrying

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Working at over head height

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Twisting/reaching/bending

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards- Hazardous Substances

• Chemicals

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Spill potential

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Dust/fumes/vapour/gases

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Fire/explosion/reactive properties

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Acid/corrosive material

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Aerosols/compressed gas

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Hazardous material storage & handling

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards-Biological

• Blood/bodily fluids

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Virus/bacteria

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Waste disposal

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Lack of hygiene/sanitation

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards-Work Environment

• Noise

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Wildlife

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Insects/bites

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Remote work location

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Weather

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Type of weather risk

  Rain

  Snow

  Hail

  Extreme Cold

  Extreme Heat

• How I control the hazard

• Weather

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Type of weather risk

  Select Rain Snow Hail Extreme Cold Extreme Heat

  • Rain
  • Snow
  • Hail
  • Extreme Cold
  • Extreme Heat

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Lighting in the work area

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Stress/fatigue

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards-Equipment

• Scaffold use

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Did you inspect the scaffold

  Yes

  No

• Were any defects found

  Yes

  No

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Ladder Use

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• Did you inspect the ladder

  Yes

  No

• Were any defects found

  Yes

  No

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Improper tools/equipment

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Defective tools/equipment

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Equipment/tools without proper guards

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Hazards-People & Personal

• Violence

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Harassment

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Mental health and stability

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Age/illness

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Personal limitations

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Working alone

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Others working overhead/below

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• Other trades working in the area

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

• New/not competent workers on site

  Yes

  No

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

  5- Negligible

• Probability Frequency

  A) Very Likely

  B) Likely

  C) Possible/Maybe

  D) Low

  E) Very Low

• How I control the hazard

  Select PPE Eliminate Barricades Change the way I work Awareness Right of Way Permits Safe work procedures Clean Up Lock Out/Tag Out (LOTO) Ergonomics MSDS (SDS) Call in Procedures Company policy Emergency Preparedness

  • PPE
  • Eliminate
  • Barricades
  • Change the way I work
  • Awareness
  • Right of Way
  • Permits
  • Safe work procedures
  • Clean Up
  • Lock Out/Tag Out (LOTO)
  • Ergonomics
  • MSDS (SDS)
  • Call in Procedures
  • Company policy
  • Emergency Preparedness

Procedures

• Did you properly lock out & tag any defective tools/equipment or energy sources?

  Yes

  No

  N/A

• Did you notify nearby workers of any hazards that may affect them?

  Yes

  No

  N/A

• Did you correct any Health and Safety hazards that you identified? This can be done by eliminating the hazard, PPE, etc.

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• PPE Required:

  Yes

  No

• Safety Glasses

• Hearing Protection

• Hard Hat

• Gloves

• Specialty PPE

  Yes

  No

  N/A

• If specialty PPE required, please specify.

• PPE Inspected?

  Yes

  No

  N/A

After Shift/Job Sign Off

• Was the work area cleaned up/materials store and disposed of properly?

  Yes

  No

• Did any incidents occur?

  Yes

  No

• If yes, explain:

WORKER NAME (print)

• Print

• SIGNATURE

  Sign

• Date & Time

  Date