PRE START HAZARD ID/CONTROL

• Job No.

• Conducted on

  Date

BRIEF DESCRIPTION OF TASK

SIGNIFICANT HAZARDS

• Work at height

  Yes

  No

  N/A

• working from ladder

  Yes

  No

  N/A

• Working from scaffold

  Yes

  No

  N/A

• Working from EWP

  Yes

  No

  N/A

• Electricity

  Yes

  No

  N/A

• Confined space

  Yes

  No

  N/A

• Overhead hazard

  Yes

  No

  N/A

• Underfoot hazard

  Yes

  No

  N/A

• Heavy/awkward lifting

  Yes

  No

  N/A

• Noise

  Yes

  No

  N/A

• Excavations

  Yes

  No

  N/A

• Floor openings

  Yes

  No

  N/A

• Chemicals

  Yes

  No

  N/A

• Poor houskeeping

  Yes

  No

  N/A

• Other trades/members of the public

  Yes

  No

  N/A

• Additional hazard

  Yes

  No

  N/A

• Additional hazard

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Eye protection

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Hi-visibility vest/clothing

  Yes

  No

  N/A

• Hard hat

  Yes

  No

  N/A

• Respiratory protection

  Yes

  No

  N/A

• Safety harness

  Yes

  No

  N/A

• Isolation lock/tag

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

CONTROLS IN PLACE

• Fall protection in place

  Yes

  No

  N/A

• Ladders safe and secured

  Yes

  No

  N/A

• Scaffold tagged and secured

  Yes

  No

  N/A

• EWP maintained/fit for purpose

  Yes

  No

  N/A

• Electrical supply isolated/locked/tagged

  Yes

  No

  N/A

• Electrical safety device (RCD)

  Yes

  No

  N/A

• Portable electrical equipment tested/tagged

  Yes

  No

  N/A

• Clear safe underfoot

  Yes

  No

  N/A

• Floor openings covered

  Yes

  No

  N/A

• Excavations identified/fall protection

  Yes

  No

  N/A

• Protection from overhead hazards

  Yes

  No

  N/A

• First aid kit availiable

  Yes

  No

  N/A

• Fire extinguisher availiable

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

LIST ANY WORK PERMITS/MBIE NOTIFICATIONS

Please sign and email the report to the OSH Coordinator.

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  Date

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