Starline - Daily Hazard Assessment

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Number of workers on site

• Location
  Address

• Work to be performed

  Select Rope access work Leading edge work Swing stage work Aerial lifts work Scaffolding work Slab edge

  • Rope access work
  • Leading edge work
  • Swing stage work
  • Aerial lifts work
  • Scaffolding work
  • Slab edge

• Sub-contractors on site

  Yes

  No

  N/A

• Type of risk

  Select

Procedures, policies to control, risk elimination

• Safe work procedures reviewed and signed

• Fall protection plan relevant

• Fall protection plan reviewed and signed

• Training & instructions provided

• Risk assessment performed

• Pre-use inspection completed

• New/Young worker mentoring

• Toolbox completed & signed

Personal protective equipment (PPE) inspected?:

• Hard hat, High-vis Vest, Safety boots

• Use of safety harness

• Harness inspection

• Lanyard inspection

• Ropes

• Ladders

• Appropriate gloves

• Hearing protection

• Safety glasses

• Full face shield

• Other - specify:

Work hazard assessment - 1/2

• Risk of slipping or tripping?

  Yes

  No

• Risk of falling?

  Yes

  No

• Risk of fogging glasses?

  Yes

  No

• Use of scaffold?

  Yes

  No

• Risk of falling material?

  Yes

  No

• Required to work above your head?

  Yes

  No

• Risk of sprain (push, pull, lift)?

  Yes

  No

• Risko of foreign body in the eye?

  Yes

  No

• Others working above or below?

  Yes

  No

• Need a safety barricade or tape?

  Yes

  No

• Unstable position?

  Yes

  No

• Enough employees to perform work?

  Yes

  No

• Adequate tools for work?

  Yes

  No

• Area clean and in good order?

  Yes

  No

• Presence of power lines?

  Yes

  No

• Presence of dust?

  Yes

  No

• Presence of chemicals?

  Yes

  No

• Weather: Wind over 25 km/h?

  Yes

  No

• Weather: Rain or snow?

  Yes

  No

• Weather: Extreme temperatures?

  Yes

  No

Work hazard assessment - 2/2

• Task conducted

• Location(s) / Drop(s) - mark in the photo

  Media

• Is rigging ropes required?

  Yes

  No

• Risks associated with work

  Select Work above head Fall Drop Other trades in the area High traffic area Other

  • Work above head
  • Fall
  • Drop
  • Other trades in the area
  • High traffic area
  • Other

• Specify

• Control measures taken

  Select Fall arrest Fall restraint Control zones and/or signs Tethers for tools/equipment Anchor points Guardrails Using proper tool Clear communication Maintain housekeeping Other

  • Fall arrest
  • Fall restraint
  • Control zones and/or signs
  • Tethers for tools/equipment
  • Anchor points
  • Guardrails
  • Using proper tool
  • Clear communication
  • Maintain housekeeping
  • Other

• Specify:

Worker's name and signature

• Technician

  Sign