Title Page
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Conducted on
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General Contractor
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Project
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Prepared by
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Document No.
HAZARDS AND CONTROLS
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CHECK ALL LOW RISK HAZARDS THAT APPLY:
- Silica/Concrete
- Asbestos
- Mould
- Fiberglass/Insulation
- Drywall
- Working in tight area
- Parts of body in line-of-fire
- Working above your head
- Pinch points identified
- Repetitive motion
- Repetitive work in awkward position
- Spill potential
- MSDS reviewed
- Ventilation required
- Heat Stress/Cold exposure
- Other workers in area
- Inadequate lighting
- Housekeeping
- Sensitive equipment in area
- Burn/Heat sources
- Compressed gassess
- Energized equipment in area
- Welding/Grinding
- Electrical Cords/Tools
- Equipment/Tools
- Lockout procedure in place
- Airborne particles - chipping
- Partially obstructed
- Slip/Trip potential identified
- Excavations
- Scaffold - inspected & tagged
- Barricades
- Hole/Dangerous openings
- Protect from falling items
- Powered platforms - AWP
- Others working above/below
- Fall Arrest
- Ladders
- Distractions in work area
- Working Alone (Communication)
- Heavy Lift/Awkward Position
- External noise levels
- Dust
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OTHERS
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CHECK ALL PREVENTATIVE CONTROLS TAKEN
- Toolbox Meeting
- Safe Work Reviewed Daily
- Trained Operators
- Equipment Working Properly
- Maintain PPE
- Maintain Fencing & Hoarding
- Traffic Control Personnel
- Follow Silica Control Policy
- Follow Asbestos Control Policy
- Asbestos Hazard Assessment Kept Onsite
- Maintain Proper Lighting Levels
- Follow Equipment Operating Instructions & Manufacturers Specifications
- Demolition Personnel are not Able to Cut Connected Cables
- Call to Locate Buried Wires
- Maintain Housekeeping
- Employees are Briefed on Emergency Policy & Evacuation Plan
- Wetting of Concrete
- Vacuuming of Slurry
- Negative Air Units
- Assure Discharge Air does not affect Others
- Maintain Eye Contact with Operators
- Use of Fall Protection Equipment
- Use of Hot Work Procedure
- Load Calculations Completed
- Proper Lifting Procedure
- Use of Spotter
- Cover Open Holes
- No Excavation over 4ft to be Entered
- Fall Protection Plan
- Barrier Tape
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OTHERS
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CHECK ALL MEDIUM RISK HAZARDS THAT APPLY:
- Silica/Concrete
- Asbestos
- Mould
- Fiberglass/Insulation
- Drywall
- Working in tight area
- Parts of body in line-of-fire
- Working above your head
- Pinch points identified
- Repetitive motion
- Repetitive work in awkward position
- Spill potential
- MSDS reviewed
- Ventilation required
- Heat Stress/Cold exposure
- Other workers in area
- Inadequate lighting
- Housekeeping
- Sensitive equipment in area
- Burn/Heat sources
- Compressed gassess
- Energized equipment in area
- Welding/Grinding
- Electrical Cords/Tools
- Equipment/Tools
- Lockout procedure in place
- Airborne particles - chipping
- Partially obstructed
- Slip/Trip potential identified
- Excavations
- Scaffold - inspected & tagged
- Barricades
- Hole/Dangerous openings
- Protect from falling items
- Powered platforms - AWP
- Others working above/below
- Fall Arrest
- Ladders
- Distractions in work area
- Working Alone (Communication)
- Heavy Lift/Awkward Position
- External noise levels
- Dust
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OTHERS
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CHECK ALL PREVENTATIVE CONTROLS TAKEN
- Toolbox Meeting
- Safe Work Reviewed Daily
- Trained Operators
- Equipment Working Properly
- Maintain PPE
- Maintain Fencing & Hoarding
- Traffic Control Personnel
- Follow Silica Control Policy
- Follow Asbestos Control Policy
- Asbestos Hazard Assessment Kept Onsite
- Maintain Proper Lighting Levels
- Follow Equipment Operating Instructions & Manufacturers Specifications
- Demolition Personnel are not Able to Cut Connected Cables
- Call to Locate Buried Wires
- Maintain Housekeeping
- Employees are Briefed on Emergency Policy & Evacuation Plan
- Wetting of Concrete
- Vacuuming of Slurry
- Negative Air Units
- Assure Discharge Air does not affect Others
- Maintain Eye Contact with Operators
- Use of Fall Protection Equipment
- Use of Hot Work Procedure
- Load Calculations Completed
- Proper Lifting Procedure
- Use of Spotter
- Cover Open Holes
- No Excavation over 4ft to be Entered
- Fall Protection Plan
- Barrier Tape
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OTHERS
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CHECK ALL HIGH RISK HAZARDS THAT APPLY:
- Silica/Concrete
- Asbestos
- Mould
- Fiberglass/Insulation
- Drywall
- Working in tight area
- Parts of body in line-of-fire
- Working above your head
- Pinch points identified
- Repetitive motion
- Repetitive work in awkward position
- Spill potential
- MSDS reviewed
- Ventilation required
- Heat Stress/Cold exposure
- Other workers in area
- Inadequate lighting
- Housekeeping
- Sensitive equipment in area
- Burn/Heat sources
- Compressed gassess
- Energized equipment in area
- Welding/Grinding
- Electrical Cords/Tools
- Equipment/Tools
- Lockout procedure in place
- Airborne particles - chipping
- Partially obstructed
- Slip/Trip potential identified
- Excavations
- Scaffold - inspected & tagged
- Barricades
- Hole/Dangerous openings
- Protect from falling items
- Powered platforms - AWP
- Others working above/below
- Fall Arrest
- Ladders
- Distractions in work area
- Working Alone (Communication)
- Heavy Lift/Awkward Position
- External noise levels
- Dust
-
OTHERS
-
CHECK ALL PREVENTATIVE CONTROLS TAKEN
- Toolbox Meeting
- Safe Work Reviewed Daily
- Trained Operators
- Equipment Working Properly
- Maintain PPE
- Maintain Fencing & Hoarding
- Traffic Control Personnel
- Follow Silica Control Policy
- Follow Asbestos Control Policy
- Asbestos Hazard Assessment Kept Onsite
- Maintain Proper Lighting Levels
- Follow Equipment Operating Instructions & Manufacturers Specifications
- Demolition Personnel are not Able to Cut Connected Cables
- Call to Locate Buried Wires
- Maintain Housekeeping
- Employees are Briefed on Emergency Policy & Evacuation Plan
- Wetting of Concrete
- Vacuuming of Slurry
- Negative Air Units
- Assure Discharge Air does not affect Others
- Maintain Eye Contact with Operators
- Use of Fall Protection Equipment
- Use of Hot Work Procedure
- Load Calculations Completed
- Proper Lifting Procedure
- Use of Spotter
- Cover Open Holes
- No Excavation over 4ft to be Entered
- Fall Protection Plan
- Barrier Tape
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OTHERS
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CHECK ALL EXTREME HAZARDS THAT APPLY:
- Silica/Concrete
- Asbestos
- Mould
- Fiberglass/Insulation
- Drywall
- Working in tight area
- Parts of body in line-of-fire
- Working above your head
- Pinch points identified
- Repetitive motion
- Repetitive work in awkward position
- Spill potential
- MSDS reviewed
- Ventilation required
- Heat Stress/Cold exposure
- Other workers in area
- Inadequate lighting
- Housekeeping
- Sensitive equipment in area
- Burn/Heat sources
- Compressed gassess
- Energized equipment in area
- Welding/Grinding
- Electrical Cords/Tools
- Equipment/Tools
- Lockout procedure in place
- Airborne particles - chipping
- Partially obstructed
- Slip/Trip potential identified
- Excavations
- Scaffold - inspected & tagged
- Barricades
- Hole/Dangerous openings
- Protect from falling items
- Powered platforms - AWP
- Others working above/below
- Fall Arrest
- Ladders
- Distractions in work area
- Working Alone (Communication)
- Heavy Lift/Awkward Position
- External noise levels
- Dust
-
OTHERS
-
CHECK ALL PREVENTATIVE CONTROLS TAKEN
- Toolbox Meeting
- Safe Work Reviewed Daily
- Trained Operators
- Equipment Working Properly
- Maintain PPE
- Maintain Fencing & Hoarding
- Traffic Control Personnel
- Follow Silica Control Policy
- Follow Asbestos Control Policy
- Asbestos Hazard Assessment Kept Onsite
- Maintain Proper Lighting Levels
- Follow Equipment Operating Instructions & Manufacturers Specifications
- Demolition Personnel are not Able to Cut Connected Cables
- Call to Locate Buried Wires
- Maintain Housekeeping
- Employees are Briefed on Emergency Policy & Evacuation Plan
- Wetting of Concrete
- Vacuuming of Slurry
- Negative Air Units
- Assure Discharge Air does not affect Others
- Maintain Eye Contact with Operators
- Use of Fall Protection Equipment
- Use of Hot Work Procedure
- Load Calculations Completed
- Proper Lifting Procedure
- Use of Spotter
- Cover Open Holes
- No Excavation over 4ft to be Entered
- Fall Protection Plan
- Barrier Tape
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OTHERS
PERSONAL PROTECTIVE EQUIPMENT
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CHECK ALL PPE REQUIRED
- Hard Hat
- Steel Toed Boots
- Eye Protection
- Face Shield
- Hi-V Vests
- Gloves
- Fall Protection Equipment
- Hearing Protection
- Half Mask Respirator
- Full Face Respirator
- Dust Mask
- P100 Filter
- Organic Vapours Filter
- Co Monitor
- Welding Glasses
- Welding Gloves
- Welders Smock
- Protective Coveralls
- Rubber Boots
- Nitrate Gloves
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OTHERS
EQUIPMENT ONSITE
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CHECK ALL EQUIPMENT USED
- Negative Air Unit
- Crane
- Excavator
- Skidsteer
- Air Compressor
- Coping Fans
- Poly Sheeting
- Hoarding
- Site Fencing
- Slurry Vac
- Concrete Saw
- Site Fencing
- Gas Axe
- Telehandler
- Man Basket
- Airless Sprayer
- Bleach
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OTHERS
PROCEDURE
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LIST PROCEDURE IN POINT FORM
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All waste cleaned up or removed?
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All tools/equipment removed?
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Task area cleaned at shifts end?
Signatures
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Foreman Signature
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Employee Signature
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Employee Signature
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Employee Signature
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Employee Signature
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Employee Signature
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Employee Signature
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Employee Signature
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Employee Signature
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Employee Signature
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Employee Signature
