Risk Assessment and Action Plan Report

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Department

  Select

• Department Manager:

• Farm Manager:

• Reason for Assessment being conducted:

  Select Workplace inspection (e.g. JHSC workplace inspection, pre-shift inspection, housekeeping inspection, supervisor shift-report) Meeting (e.g. JHSC, daily production meeting, management meeting, meeting with regulatory body (Fire dep't, Min of Labour) Hazards identified (e.g. in unsafe act/condition reports, hazard alerts, audits, etc.)

  • Workplace inspection (e.g. JHSC workplace inspection, pre-shift inspection, housekeeping inspection, supervisor shift-report)
  • Meeting (e.g. JHSC, daily production meeting, management meeting, meeting with regulatory body (Fire dep't, Min of Labour)
  • Hazards identified (e.g. in unsafe act/condition reports, hazard alerts, audits, etc.)

• Is a member of the JHSC present for the Risk assesment?

  Yes

  No

  N/A

• Why is the JHSC not involved in this Risk assessment?

• Who is the JHSC Member?

• What department do they represent?

  Select

• Use this tool to determine the Risk level rating

  

RECOGNIZE

HAZARD

• What activity or hazard could cause injury or illness?

• What hazard groups can cause injury, illness, property damage or damage to the environment? (select all that apply)

  Select Physical Safety MSD Chemical Physical Agent Psychosocial Biological Manual Material Handeling

  • Physical Safety
  • MSD
  • Chemical
  • Physical Agent
  • Psychosocial
  • Biological
  • Manual Material Handeling

• What is the source of the hazard to the associate/environment?

  Select Compressed Air High Pressure Fluids Confined Space Driving Electrical Material Handling Material Storage Molten Material Machine or Equipment Slip or Trip Temperature Vehicular Hazards Working at Heights

  • Compressed Air
  • High Pressure Fluids
  • Confined Space
  • Driving
  • Electrical
  • Material Handling
  • Material Storage
  • Molten Material
  • Machine or Equipment
  • Slip or Trip
  • Temperature
  • Vehicular Hazards
  • Working at Heights

• What is the potential outcome of exposure to the hazard?

  Select Skin injection Skin injection Asphyxiation Engulfment Entrapment Explosion Collision Contact with pedestrian Other Stress Violence Arc flash Electrocution Fire hazard Crushing Fire hazard Laceration Puncture or injection Sharp edges - laceration/contusion Struck by Worker contact Fire hazard Trip hazard Worker contact Burn Fire Flying particles/materials - impact or injection Full body pinch point - crushing Grinding/Sanding - friction & abrasion Impact - stabbing & puncture In-running nip - entanglement, drawing in Moving part - entanglement, cutting, shear Pinch point - crushing or shear Rotating or sharp part - cutting or shearing Rotation - entanglement Sharp edges - laceration/contusion Worker contact – laceration/contusion/puncture/other Falls to same height Burn/Scald Falling to surface below Objects falling on workers below Other

  • Skin injection
  • Skin injection
  • Asphyxiation
  • Engulfment
  • Entrapment
  • Explosion
  • Collision
  • Contact with pedestrian
  • Other
  • Stress
  • Violence
  • Arc flash
  • Electrocution
  • Fire hazard
  • Crushing
  • Fire hazard
  • Laceration
  • Puncture or injection
  • Sharp edges - laceration/contusion
  • Struck by
  • Worker contact
  • Fire hazard
  • Trip hazard
  • Worker contact
  • Burn
  • Fire
  • Flying particles/materials - impact or injection
  • Full body pinch point - crushing
  • Grinding/Sanding - friction & abrasion
  • Impact - stabbing & puncture
  • In-running nip - entanglement, drawing in
  • Moving part - entanglement, cutting, shear
  • Pinch point - crushing or shear
  • Rotating or sharp part - cutting or shearing
  • Rotation - entanglement
  • Sharp edges - laceration/contusion
  • Worker contact – laceration/contusion/puncture/other
  • Falls to same height
  • Burn/Scald
  • Falling to surface below
  • Objects falling on workers below
  • Other

• What is the source of the hazard to the associate/environment?

  Select Awkward Posture High Force Demands Poor Tool or Equipment Design Poor Workstation Design Repetition Static Posture

  • Awkward Posture
  • High Force Demands
  • Poor Tool or Equipment Design
  • Poor Workstation Design
  • Repetition
  • Static Posture

• What is the potential outcome of exposure to the hazard?

  Select MSD injury Other

  • MSD injury
  • Other

• What is the source of the hazard to the associate/environment?

  Select Combustible Compressed Gas Corrosive Flammable Reactivity Toxic

  • Combustible
  • Compressed Gas
  • Corrosive
  • Flammable
  • Reactivity
  • Toxic

• What is the potential outcome of exposure to the hazard?

  Select Fire/Explosion Violent release of energy/gas Acid - skin burn/mucous membrane exposure Acid/base incompatibility reaction Alkaline - skin burn/mucous membrane exposure Liquid - Fire/explosion Gas - Fire/explosion Dangerous reaction Absorption - Illness Dermatitis Ingestion – Illness Ingestion – Carcinogen Inhalation – Illness Inhalation - Carcinogen Injection – Illness Injection - Carcinogen

  • Fire/Explosion
  • Violent release of energy/gas
  • Acid - skin burn/mucous membrane exposure
  • Acid/base incompatibility reaction
  • Alkaline - skin burn/mucous membrane exposure
  • Liquid - Fire/explosion
  • Gas - Fire/explosion
  • Dangerous reaction
  • Absorption - Illness
  • Dermatitis
  • Ingestion – Illness
  • Ingestion – Carcinogen
  • Inhalation – Illness
  • Inhalation - Carcinogen
  • Injection – Illness
  • Injection - Carcinogen

• If Hazardous materials are present, are there SDS sheets available to associates at all times and are associates trained in WHMIS 2015?

  Compliant

  Non-Compliant

  N/A

• What SDS sheet or training is required?

  Yes

  No

  N/A

• What is the source of the hazard to the associate/environment?

  Select Extreme Cold Extreme Heat Lighting Noise UV Exposure Vibration

  • Extreme Cold
  • Extreme Heat
  • Lighting
  • Noise
  • UV Exposure
  • Vibration

• What is the potential outcome of exposure to the hazard?

  Select Cold stress Heat stress Hazard exposure due to lack of visibility Eye strain Hearing loss Skin or eye damage Hand/Arm - MSD or vascular disorder Whole body - Back pain

  • Cold stress
  • Heat stress
  • Hazard exposure due to lack of visibility
  • Eye strain
  • Hearing loss
  • Skin or eye damage
  • Hand/Arm - MSD or vascular disorder
  • Whole body - Back pain

• What is the source of the hazard to the associate/environment?

  Select Boredom Harassment Stress Violence Work overload Long hours

  • Boredom
  • Harassment
  • Stress
  • Violence
  • Work overload
  • Long hours

• What is the potential outcome of exposure to the hazard?

  Select Mental Illness Violent Situation Physical Health Decline

  • Mental Illness
  • Violent Situation
  • Physical Health Decline

• What is the source of the hazard to the associate/environment?

  Select Bacteria Mold Viral

  • Bacteria
  • Mold
  • Viral

• What is the potential outcome of exposure to the hazard?

  Illness/Disease

• What is the source of the hazard to the associate/environment?

  Select Bending Lifting Pushing or Pulling

  • Bending
  • Lifting
  • Pushing or Pulling

• What is the potential outcome of exposure to the hazard?

  Strain

• Hazard Images and DIagrams

  Media

• Additional Comments

ASSES

Assessment

• What is the probability of an incident occurring?

  1 - Very Improbable

  2 - Improbable

  3 - Probable

  4 - Very Probable

  5 - Inevitable

• How often is the job task interacting with the hazard?

  1 - Very Rarely

  2 - Infrequent

  3 - Occasional

  4 - Frequent

  5 - Continuously

• How severe could an incident be?

  2- Minor

  4 - Moderate

  6 - Serious

  15 - Major

  20 - Fatal

• What is the risk level? (Probability + Frequency x Severity)

  Select Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage) Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage). Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

  • Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage)
  • Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage).
  • Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence
  • Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority
  • Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

• If immediate action is required; issue a work order from the app to the Maintenance Manager of the location.

• What is being done immediately to prevent an incident?

• What is the Risk Priotrity?

  Low

  Medium

  High

  ASAP/Immediate

• Additional Comments:

CONTROLS AND RECCOMENTDATIONS

• Use this tool when considering control implementation and recommendations.

  
Control and Recommendation

• What legal requirements, codes, benchmarks or standards apply to the identified hazards, work processes or work activities?

  Select OHSA CSA Electrical Fire/Building Other

  • OHSA
  • CSA
  • Electrical
  • Fire/Building
  • Other

• What legal requirement is in non-coompliance?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Are controls immediately put into place or recommended introducing a new hazard? (congestion, confined space, etc.)

  Safe

  At Risk

  N/A

• Describe in detail what the new hazard identified is:

• Will new training be required for the new controls put into place?

  Yes

  No

  N/A

• What training will be required?

• Are any labels, signs or decals required if controls are put in place?

  Yes

  No

  N/A

• What labels, signs or decals are required?

• Is additional PPE required?

  Safe

  At Risk

  N/A

• What PPE is required?

• Is a Safety Alert required or alteration to a hazard checklist?

  Yes

  No

  N/A

• What action is required?

• What CSA Standard is in non-compliance?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• What electrical code item is non-compliant?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• What fire/building code item is non-compliant?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Describe the non-compliance

  Yes

  No

  N/A

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Recommended timeline of completion:

  Date

• Additional Comments:

EVALUATE

Evaluation

• Following recommended control implementation, how likely is the hazard to cause injury or illness now?

  1 - Very Improbable

  2 - Improbable

  3 - Probable

  4 - Very Probable

  5 - Inevitable

• Following recommended control implementation, how often is the job task interacting with the hazard?

  1 - Very Rarely

  2 - Infrequent

  3 - Occasional

  4 - Frequent

  5 - Continuously

• Following recommended control implementation, how severe could an incident be?

  2- Minor

  4 - Moderate

  6 - Serious

  15 - Major

  20 - Fatal

• Following recommended control implementation, what is the level of risk? (Probability + Frequency x Severity)

  Select Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage) Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage). Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

  • Class E (1-6): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage)
  • Class D (7-12): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage).
  • Class C (13-79): A condition or practice with moderate likelihood to cause permanent disability, loss of life or body part with moderate likely hood of occurrence
  • Class B (80-159): A condition or practice that is likely to cause permanent disability, loss of life or body part with moderate likely hood of occurrence - High Priority
  • Class A (160-200): A condition or practice that is likely to cause permanent disability, loss of life or body part with high likely hood of occurrence - Immediate action must be taken

• Additional Comments:

• Auditor:

  Sign

• JHSC Rep:

  Sign

• Supervisor/Manager of the Department:

  Sign

• Farm Manager:

  Sign

• Responsible Party for Controls Implementation:

  Sign