Non-routine Risk Assessment for Field

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• INSTRUCTIONS:
  -------------------------------------
  
  1. Fill out required fields and answer other questions as needed.
  2. Add photos and comments as needed.
  3. To add a Corrective Measure, click on the paperclip icon then click on "Add Action". Provide a description, assign to a member, set priority and then set the due date.
  4. Complete audit by providing a digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  

  

Summary of Control Plan

• HSE Control Plan

  Select Chemical Exposure Material Handling Use of Power Tools PPE Emergency Response Plan Biological/Natural Exposure

  • Chemical Exposure
  • Material Handling
  • Use of Power Tools
  • PPE
  • Emergency Response Plan
  • Biological/Natural Exposure

• Permits Required

  Hot Work

  Confined Spaces

  Fall Protection

  Live Energy

  Line breaking / LO-TO

• Leave the description of controls for medium and high risks here

Contractor Performing Work

• Is contractor performing the work?

  YES

  NO

• There is a contractor safety declaration available for all the contractors involved in the project

  ✔

  ✖

  N/A

• The contractors’ employees have been trained on the Honeywell HSE procedures

  ✔

  ✖

  N/A

• The contractors have taken safety precautions to protect Honeywell employees

  ✔

  ✖

  N/A

• Contractor’s Name and Signature

  Sign

Observations

• 

• Are applicable permits available/ posted ?

  YES

  NO

  N/A

• Is PPE being appropriately used?

  YES

  NO

  N/A

• Are control methods used?

  YES

  NO

  N/A

• Are working areas cleaned and secure after work is completed?

  YES

  NO

  N/A

• Have the affected employees been notified of the work/hazards?

  YES

  NO

  N/A

• Are critical behaviours identified and observed?

  YES

  NO

  N/A

• Supervisor / Project Leader’s Name and Signature

  Sign

• Cell Risk Assessment needs to be up-dated

  YES

  NO

  N/A

Non-Routine HSE Work Plan

• Date of the Non-routine Work

  Date

• Department / Work station

• Brief Task Description

• 

Step 1. Hazardous Tasks

• Define the Hazardous Tasks

  Select Hot Work (example: welding, torching, grinding) Confined Spaces (example: wells, trash compactors, ventilation systems) Heights (example: > 1.2 m or 4 ft, < 5 m or 15 ft from ledge of a roof, ladder) Live energy (example: electrical, pneumatic, hydraulic) Lockout or Line breaking (example: pressurized, chemical pipes) Lifting equipment (example: hoist, lift truck, elevator) Material handling (example: Manual lifting, moving object, equipment) Powered manual tools (example: electric, pneumatic) Working with sharp objects (example: changing blades or needles) Chemical exposure (example: storage, handling, spills, wastes) Biological/Natural exposure (example: BBP, infectious environments, rodents) Other Management of Change (new or changes to equipment/practices, or impacts Process Safety Management requirements) Environment (work generates wastes or involves environmental compliance or permit issues with equipment or wastes?)

  • Hot Work (example: welding, torching, grinding)
  • Confined Spaces (example: wells, trash compactors, ventilation systems)
  • Heights (example: > 1.2 m or 4 ft, < 5 m or 15 ft from ledge of a roof, ladder)
  • Live energy (example: electrical, pneumatic, hydraulic)
  • Lockout or Line breaking (example: pressurized, chemical pipes)
  • Lifting equipment (example: hoist, lift truck, elevator)
  • Material handling (example: Manual lifting, moving object, equipment)
  • Powered manual tools (example: electric, pneumatic)
  • Working with sharp objects (example: changing blades or needles)
  • Chemical exposure (example: storage, handling, spills, wastes)
  • Biological/Natural exposure (example: BBP, infectious environments, rodents)
  • Other
  • Management of Change (new or changes to equipment/practices, or impacts Process Safety Management requirements)
  • Environment (work generates wastes or involves environmental compliance or permit issues with equipment or wastes?)

• 

• Specify Hazardous Task here

Step 2. Controls

• Define the Controls

  Eliminate Risk

  Substitute Risk

  Engineering Controls

  Administrative Controls

• Select applicable Administrative Control

  Standard Operating Procedure (SOP)

  Task Organisation (ex. Job rotation, use of lifting devices, etc.)

  Cell Risk Assessment (CRA)

  Other

• Specify Administrative Control here

• Identify required PPE

  Select hearing protective devices respiratory protective equipment eye and face protection safety helmets fall arrest harnesses skin protection, such as gloves, gauntlets and sunscreen clothing, such as high visibility vests, life jackets and coveralls footwear, such as safety boots and rubber boots Other

  • hearing protective devices
  • respiratory protective equipment
  • eye and face protection
  • safety helmets
  • fall arrest harnesses
  • skin protection, such as gloves, gauntlets and sunscreen
  • clothing, such as high visibility vests, life jackets and coveralls
  • footwear, such as safety boots and rubber boots
  • Other

• Specify PPE here

Step 3. Risk Level

• Define the Risk Level with Current Control Methods in Place

  

• Probability

  Almost Certain

  Highly Likely

  Likely

  Unlikely

  Rare

• Severity

  Catastrophic

  Major

  Serious

  Minor

  Negligible

• Identify Risk Level

  High

  Medium

  Low

• 

• 

• 

Risk Assessment / Authorization

• Authorized Employees (Honeywell or contractors) : CLick "Add Name"

Name

• Authorized Employee’s Name and Signature

  Sign

• Project Leader’s Name and Signature

  Sign

Indicate risk level based on result of Step 3

• Control methods are in place and documented; the risk level is

  High

  Medium

  Low

• no other authorization needed, perform the work

• Supervisor/ Project Leader's Name and Signature

  Sign

• HSE or Site Leader's Name and Signature

  Sign

Document any issues / concerns developed from this work

• Leave Notes/comments here

•