Risk Assessment-2.0

• Risk Assessment No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Crew

• Location
  Address

Section 1: Management Oversight

• Person in Charge (PIC) present

  Safe

  Caution

  UnSafe

  N / A

• Required Paperwork

  Safe

  Caution

  UnSafe

  N / A

Section 2: Emergency Action Plan

• Emergency contact known

  Safe

  Caution

  UnSafe

  N / A

• 1st Aid & Fire Extinguisher

  Safe

  Caution

  UnSafe

  N / A

Section 3: Job Safety Analysis

• JSA Match Work scope Activities

  Safe

  Caution

  UnSafe

  N / A

• SimOps / ConOps

  Safe

  Caution

  UnSafe

  N / A

• Energy Control: prior to work

  Safe

  Caution

  UnSafe

  N / A

• Power line Aviodance

  Safe

  Caution

  UnSafe

  N / A

• CHECKLIST

• Safety Cones

  Safe

  Caution

  UnSafe

  N / A

• Plenty of drinkable H2O

  Safe

  Caution

  UnSafe

  N / A

• Shade available

  Safe

  Caution

  UnSafe

  N / A

• Heat Matrix and or Cold Awareness addressed

  Safe

  Caution

  UnSafe

  N / A

• HAZARD IDENTIFICATION & MITIGATION

• Pressure / Energy

  Safe

  Caution

  UnSafe

  N / A

• Vehicle Movement

  Safe

  Caution

  UnSafe

  N / A

• Electrical Contact

  Safe

  Caution

  UnSafe

  N / A

• Fall Potential

  Safe

  Caution

  UnSafe

  N / A

• Chemical Exposure

  Safe

  Caution

  UnSafe

  N / A

• Tool use

  Safe

  Caution

  UnSafe

  N / A

• Physical Stressors

  Safe

  Caution

  UnSafe

  N / A

• Environmental factors

  Safe

  Caution

  UnSafe

  N / A

• Walk / Work surfaces

  Safe

  Caution

  UnSafe

  N / A

Section 4: Job Walk Observations

• Observation # 1

  Safe

  Caution

  UnSafe

  N / A

• Action Item # 1

• Observation # 2

  Safe

  Caution

  UnSafe

  N / A

• Action Item # 2

• Observation # 3

  Safe

  Caution

  UnSafe

  N / A

• Action Item # 3

• Observation # 4

  Safe

  Caution

  UnSafe

  N / A

• Action Item # 4

Section 6: Acknowledgment

• D.P.S.I. Safety Representative

  Sign