• Questions to be answered
    1. Is the area safe to work in?
    2. Will the activities of other crews interfere with safe operations?
    3. Has a job hazard analysis been completed and do workers understand their assignments?
    4. Have the proper tools and equipment been provided?
    5. Are tools and equipment in safe operating condition?
    6. Has proper P.P.E. been provided?
    7. Are you knowledgable on the use of the P.P.E.?
    8. Can the crew communicate effectively or are there restrictions to prevent clear understanding of what is being conveyed?
    9. If chemicals are being used, is the crew aware of the hazards and safety controls required to safely complete the work assignment?
    10. Is the the crew aware that the P.S.I. is there to assist them in getting the job done safely?
    11. Have workers been encouraged to make suggestions to assist in completing the job assignments safely?
    12. Has the crew been advised to report any unsafe acts or unsafe conditions to their supervisors?

Environmental Hazards

  • Spill potential

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Weather conditions

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • MSDS reviewed

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Ventilation required

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Heat stress / Cold exposure

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Other workers in area

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Lighting levels to low

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Housekeeping

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

Activity Hazards

  • Welding / Grinding

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Burn / Heat source

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Compressed gasses

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Energized equipment

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Electrical cords / tools - condition

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Equipment / Tools inspected

  • Enter the reason there was no inspection done.

  • Was there any defective equipment or tools found?

  • Equipment / tool
  • Defective item

  • Tap to add picture

  • Was the defective item tagged and removed for service?

  • Why was the defective item not tagged and removed for servicing?

  • Critical lift meeting

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Lockout procedure in place

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Airborne particles in place

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

Ergonomics Hazards

  • Working in tight areas

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Parts of the body in line of fire

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Working above your head

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Pinch points identified

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Repetitive motion

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

Work at Height Hazards

  • Barricades, flagging and signs

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Hole coverings in place

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Protection from falling items

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Powered platforms

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Others working above / below

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Fall arrest

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Ladders

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

Access / Egress Hazards

  • Scaffold (Inspection and tagged)

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Slip / trip potential identified

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Are permits required

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Evacuations

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

Personal Limitations / Hazards

  • Have clear instructions been provided

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Trained to use tools for specific task

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Competent in performing task

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Distractions in work area

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Working alone

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Communication

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Heavy lifting or awkward positioning

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • External noise levels

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

  • Physical limitations

  • What is the hazard?

  • What controls will be used to reduce or eliminate the hazard?

P.P.E. Requirements

  • Mono goggles or face shield

  • Gloves (Kevlar or leather)

  • Fire retardant clothing

  • Hearing protection

  • Respirator

  • Safety glasses

  • Additional P.P.E.

  • Item
  • Required

Task - Hazard - Control

    Task
  • Task

  • Hazard

  • Control used to eliminate or reduce hazard

Sign off

  • Do not sign until you understand and agree with the P.S.I.

  • Worker's name

  • Additional Worker
  • Worker's name

  • Supervisor's name

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