Risk Assesment

• Conducted on

  Date

• Prepared by

• Location
  Address

• Supervisor

Main Task being performed

• Enter the main task here.

• Are there any Sub Tasks?

  Yes

  No

  N/A

• Subtasks

Subtask

• Enter sub task here

Hazard Recognition - What Could Happen to us?

• Click Add to Add Hazard

Hazard

• Enter Hazards here

• How badly would we most likely be jurt

  Minor

  Significant

  Major

Negate the Hazards Above.- How can we work safely?

• Click to add safety measure.

Safety Measure For Hazard

• How will we negate the hazard

PPE that should be used

• Hard Hat

• Reflective Vest

• Gloves

• Glasses

• Protective Footwear

• Respiratory Protection

• Hearing Protection

• Cutting Goggles

• Face Shield

• Life Jacket

• Harness/Lanyard

• Tyvek Suit

• Welding Helmet

• Other

• Click Add other PPE

Other PPE

• List other PPE here

Keep Safety First In All Tasks

• Do we have the training and experience to perform this task safely?

  Yes

  No

  N/A

• DO NOT BEGIN WORK. Notify your supervisor.

• Does everyone understand how to do their individual tasks?

  Yes

  No

  N/A

• DO NOT BEGIN WORK. Notify your supervisor.

• Do we have the appropriate tools and materials and know how to use them?

  Yes

  No

  N/A

• DO NOT BEGIN WORK. Notify your supervisor.

• Are we qualified to operate and work around all equipment on project

  Yes

  No

  N/A

• DO NOT BEGIN WORK. Notify your supervisor.

Awareness Checklist

• Is special training needed?

  Yes

  No

  N/A

• What special training is needed?

  Lifting/Rigging

  Blaster's Training

  Forklift

  Powder Actuated Tool

  Other

• Click to add special training

Special Training

• List Training Here

• Are permits required?

  Yes

  No

  N/A

• Select required permits.

  Select Confined Space Hotwork Other

  • Confined Space
  • Hotwork
  • Other

• Click to add other permits

Other Permits

• Can any body part get caught in, struck by, or caught between objects?

  Yes

  No

  N/A

• Are the employees working with sharp or rough materials that require PPE

  Yes

  No

  N/A

• Can pushing, pulling, lifting bending, or twisting cause strain? If greater than 50 pounds get help.<br>

  Yes

  No

  N/A

• Do tools, machines, or equipment present any hazards?

  Yes

  No

  N/A

• Can the worker slip trip or fall?

  Yes

  No

  N/A

• Are there flammable, explosive, or electrical hazards?

  Yes

  No

  N/A

• Choose one of the hazards

  Flammable

  Explosive

  Electrical

• Fall hazards from one level to another?

  Yes

  No

  N/A

• Danger of falling into water?

  Yes

  No

  N/A

• Is excessive noise or vibration a problem?

  Yes

  No

  N/A

• Is there a danger from falling objects?

  Yes

  No

  N/A

• Is lighting a problem?

  Yes

  No

  N/A

• Can weather conditions affect safety?

  Yes

  No

  N/A

• Will there be contact with acids, toxic, or caustics?

  Yes

  No

  N/A

• Will there be exposure to dust, fumes, or mist?

  Yes

  No

  N/A

Verification

• Leaders Signature

  Sign

• Click to add attendee.

Attendee

• Attendees signature

  Sign

• Photo of attendees

  Media