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

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Slip/Trip/Fall potential

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Ground/surface condition

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Blocked exits & walkways

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Open Excavation

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Confined/restricted space

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• Was a confined Space Permit obtained?

  Yes

  No

  N/A

• How I control the hazard

  Obtain Confined Space Permit

  Buddy system at all times

  PPE

  Gas Monitor

• Cramped/tight work area

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Improper ventilation

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Hot work

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• Was a Hot Work Permit Obtained?

  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

• Vehicle/pedestrian traffic

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• How I control the hazard

  Defensive driving

  Cautious driving

  Awareness of surroundings

  Right of way

• Working at heights

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• Do you have a fall arrest plan?

  Yes

  No

  N/A

• Do you have a fall arrest rescue plan?

  Yes

  No

  N/A

• Do you have proper fall arrest equipment?

  Yes

  No

  N/A

• Was the fall arrest equipment inspected?

  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

• Falling objects

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

Hazards-Electrical

• Working on/near energized equipment

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Working on/near electricity

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• Is Lock Out/Tag out required?

  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

• Powerlines overhead/ underground

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

Hazards- Equipment

• Incorrect tools/equipment

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Defective tools/equipment

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Unguarded Equipment

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Ladder use

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• Did you inspect the ladder for defects?

  Yes

  No

  N/A

• Were any defects found during inspection?

  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

• Risk Rating

  Yes

  No

  N/A

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Loads moving or being hoisted

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Critical Lift

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

Hazards-Ergonomic

• Awkward body positioning

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Overextension

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Vibration

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Repetitive Motion

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Forceful Pushing/Pulling

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Awkward grip/load carried

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Working at over head height

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Twisting/reaching/bending

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

Hazards- Hazardous Substances

• Chemicals

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Spill potential

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Dust/fumes/vapours/gases

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Fire/explosion/reactive properties

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Acid/corrosive material

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Aerosols

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Material storage & handling

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

Hazards-Biological

• Blood/bodily fluids

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Virus/bacteria

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Waste disposal

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Lack of hygiene/sanitation

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

Hazards-Work Environment

• Noise

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Wildlife

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Insects/bites

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Remote work location

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Weather

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• Type of weather risk

  Rain

  Snow

  Hail

  Extreme Cold

  Extreme Heat

• How I control the hazard

  Hydration

  Frequent Breaks

  Crampons or Cleats

  Appropriate Clothing

  Appropriate PPE

• Lighting

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

• Stress/fatigue

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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

Hazards-People & Personal

• Violence

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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) Company Policies 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)
  • Company Policies
  • Emergency Preparedness

• Harassment

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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) Company Policies 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)
  • Company Policies
  • Emergency Preparedness

• Mental Health & Stability

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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) Company Policies 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)
  • Company Policies
  • Emergency Preparedness

• Age

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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) Company Policies 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)
  • Company Policies
  • Emergency Preparedness

• Personal limitations

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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) Company Policies 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)
  • Company Policies
  • Emergency Preparedness

• Illness

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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) Company Policies 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)
  • Company Policies
  • Emergency Preparedness

• Working alone

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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 below/overhead

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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)

  • 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)

• Other trades working in the area

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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)

  • 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)

• Workers not competent

• Risk Rating

  1- Catasprophic

  2- Critical

  3-Serious

  4- Minor

• Probability Frequency

  A) Very High

  B) High

  C) Moderate

  D) Low

  E) Negligible

• 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)

  • 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)

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