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The Manitoba Heavy Construction Association (MHCA) and the Manitoba Heavy
Construction Safety Program (MHCSP) have assembled precedent Safe Work
Procedures for your reference.
Safe Work Procedures are in all cases specific to each employer, its workers,
individual worksites & activities and related hazards.
The MHCSP Safe Work Procedures are therefore for precedent and educational
purposes only. They do not apply to any particular or actual or all work sites and
situations and should accordingly be used for structural development purposes
only.
Given the obvious uniqueness of each workplace and worksite, we do not
guarantee quality, accuracy and completeness of the information.
For assistance or guidance, please feel free to call the MHCSP offices.
Acetylene
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
35 W.H.M.I.S.
36 Chemical and Biological Substances
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Operator Training/Certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
Date:
Air Compressor
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Noise
Airborne particles
Slip/Tripping
Explosion of tank or air line
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedure
6 Personal Protective Equipment
12.3 Hearing Protection
16.4 Machine and Tool Safety
19.10 Fire and Explosion Hazards
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Operator Training
1 Designate a spotter who will be responsible for directing the driver/operator to the bank and to dump load
2 Check ground for stability before proceeding to top of bank
3 Ensure that all other workers and equipment are aware and stay clear of dump
4 Follow through with dump when spotter signals it is safe to do so
5 Once load is completely dumped, lower the box and carefully pull away from the bank
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
14 Fall Protection
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
26 Excavations and Tunnels
Date:
Backing Up
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Communication Device
Safety Vest
ROPS
Operator Certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
16 Machines, Tools and Robots
25.1 Work in Vicinity of Overhead Electrical Lines
Date:
Band Saw
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Eye Protection
Safety glasses
Hearing protection
Steel toed shoes
Dusk mask
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
8 Musculoskeletal Injuries
16 Machines, Tools & Robots
Date:
Barricade Personnel
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Traffic
Lifting
1 Load the truck with signs and barricades that are required for the site
2 Proceed to the job site
3 Block off the lane with the Lane Closed or Road closed sign in order to install the proper barricades
4 Barricades and signs installed according to signing procedures dictated by the owner or local government
5 If no set procedure, the area is barricaded to protect the workers amd the public from injury
6 When removing the barricades, they are removed in reverse order to allow safety of personnel
7 A flag person may be required to assist and egress from the construction site
8 The barricades are to be inspected daily by the barricade personnel
9 If the barricades are damaged, they are to be repaired or replaced immediately
10 On heavy traffic locations, the barricades are to be inspected after the crew has left for the day
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
8 Musculosketal Injuries
9 Working Alone or in Isolation
20 Vehicular & Pedestrian Traffic
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Repetitive Motions
MSI Injuries
Vibration
Slips, Trips & Falls
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
8 Musculoskeletal Injuries
16 Machines, Tools & Robots
Safe Work Bulletin #246
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training/certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculosketal Injuries
16 Machine, Tools and Robots
Date:
Blinding
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Confined Space
Hazardous material / chemicals
Confined Space
Eye Protection
Face Shield
SCBA
Communication Device
Steel toed boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
15 Confined Spaces
35 WHMIS
36 Chemical & Biological Substances
Date:
Boosting Batteries
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Sulphuric acid
Explosive hydrogen gas
Awkward location
Eye Protection
Acid resistant gloves
Steel toed boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Manitoba Workplace Safety & Health Regulation
6 Personal Protective Equipment
16.10 Machines, Tools and Robots
19.3 Fire and Explosive Hazards
21 Emergency Washing Stations
35 WHIMIS
36 Chemical and Biological Substances
38 Electrical Safety
Date:
CAT Operator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machine, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slips/trips
equipment malfunction
muscle strains
pinch points
overhead wires
buried cables and services
Hard Hat
Steel Toed Boots
Eye protection
Hand protection
If an emergency situation occurs while conducting this task, or there is an equipment malfunction,
engage the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protection Equipment
4 First Aid
16 Machines, Tools and Robots
12 Hearing Conservation and Noise
23 Cranes and Hoists
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16.27 Chain Saw Requirements
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Amputation
Injury from cuts
Projectiles
Bodily strains
Noise levels
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 PPE
8 Musculoskeletal Injuries
12 Hearing Conservation & Noise control
16.27 Machines, Tools & Robots
22 Powered Mobile Equipment
Date:
Change/Replace Screens
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
15 Confined Spaces
22.5 Powered Mobile Equipment
28 Scaffold & Other Elevated Work Platforms
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Muscle strain
Cutting injury/amputation
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injury
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Muscle strain
Crush by machine
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injury
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Crushed by blade/machine
Pinch points
Muscle strain
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injuries
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Explosion
Muscle strain
Burns
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injury
19.10 Compressed Gas Equipment
35 WHMIS
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Crushing
Wrenches slipping
Gloves
Safety Glasses
Steel toed Boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculosketal Injuries
15 Confined Spaces
22 Powered Mobile Equipment
Date:
Changing Tire
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Crushing
Wrenches slipping
Tire explosion
Gloves
Safety Glasses
Steel toed Boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculosketal Injuries
15 Confined Spaces
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Equipment failure
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Computer Use
Facility:
Written By:
Hazards Present:
Approved By:
Date Created
1 Chair:
2 Monitor:
3 Mouse:
4 Laptops:
5 Breaks:
6 Maintenance:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
8 Musculoskeletal Injuries
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Muscle strain
Potential death
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
23 Cranes and Hoists
32 Precast Concrete
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Claustrophobia
Inhalation of chemicals / toxins
Potential death
Asphyxiation
1 Stop and clear all work in vicinity and ensure that no workers enter the confined space
2 Ensure trained confined space standby team is present or call 911
3 Secure the site against further danger or injuries
4 Designate a worker to wait for emergency responders and lead them to accident area
5 Hoist injured worker to surface
6 Commence First Aid until relieved of responsibilities
7 Begin accident investigation
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
15.8 Confined Spaces
Date:
Written By:
Hazards Present:
Claustrophobia
Restricted entry/egress
Flammable gases
Hazardous chemicals
Pressurized liquids/gases
Water
Atmospheric hazards
Approved By:
Date Created
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
14 Fall Protection
15 Confined Spaces
26 Excavations and Tunnels
Date:
Written By:
Hazards Present:
poisonous fumes/chemicals
suffocation
Approved By:
Date Created
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedure
5 First Aid
6 Personal Protective Equipment
15 Confined Spaces
26 Excavations & Tunnels
35 WHMIS
Date:
Construction Labourers
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/trip
Muscle strain
Heavy machinery
Pinch points
Construction debris
Working alone
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
8 Musculoskeletal Injuries
12 Hearing Conservation and Noise Control
13 Entrances, Exits, Stairways and Ladders
20 Vehicular and Pedestrian Traffic
Date:
Conveyor Cleaning/Maintenance
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Injury
Amputation
Safety gloves
Steel toed boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5.5(1) First Aid
6 Personal Protective Equipment
9 Working Alone or in Isolation
14 Fall Protection
15 Confined Space
Date:
Conveyor Operation
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falling
Wrenches slipping
Eye Protection
Hard Hat
Steel Toe Boots
Crusher Operation
Lock out procedure
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Crawler Loader
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Written By:
Hazards Present:
Approved By:
Date Created
Pinch Points
Falling
Wrenches slipping
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falling
Wrenches slipping
Slips / Trips
Lifting manually
Fire Extinguisher
Eye Protection
Hard Hat
Steel Toe Boots
Snug fitting clothes
Protective mask or respirator
Hearing Protection
Crusher Operation
Lock out procedure
Housekeeping practices
Fire Extinguisher training
Manufactuers specification
Install one or more locks to hold the master switch lever in the OFF position
Turn the master key to the OFF position and remove the key
Disconnect the batteries
Place one or more locks on machine control panels, access doors or electrical panels.
A lock out is required any time repairs or maintenance is performed:
1. When cleaning or lubricating the machine
2. While clearing blocked or jammed mechanism
3. If several persons will be working on a piece of equipment, each must apply their own lock
6 A lock can be removed when:
1. All guards are back in place
2. All work is completed and tools put away
3. Notify all workers that the lock is being removed
4. All workers are positioned safely for start up
5. Contols are positioned correctly for start up
6. The machine is ready for operation
7 ONLY THE PERSON WHO APPLIED THE LOCK CAN REMOVE IT
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Cutting Torch
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Burns
Eye Injuries
Eye Protection
Face Shield
Helmet
Gloves
Coveralls, Fire retardant
- not frayed or oily
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedure
5 First Aid
6 Personal Protective Equipment
17 Welding & Allied Processes
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Crushing or asphyxiation
Inhalation of hazardous materials
Lacerations
Eye injuries
Noise
Hearing protection
Steel toed boots
Hard Hat
Safety glasses
leather gloves
Respirator
Permits
safety vest
baricades
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedstrian Traffice
22 Powered mobile equipment
33 Demolition work
Date:
Dismounting Tires
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Muscle strain
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injuries
16 Machines, Tools and Robots
35 Workplace Hazardous Materials Information
Systems
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Potential fire
Inhalation of chemicals / toxins
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Electrical Equipment
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Equipment damage
Equipment malfunction
Electrocution
Manufacturer's manual
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
16 Machies, Tools and Robots
Date:
Emergency Response
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Serious injury
Potential death
Fire/Explosion
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
18 Fire and Explosive Hazards
35 Workplace Hazardous Materials Information
Systems
36 Chemical and Biological Substances
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Equipment failure
Collision
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Electrocution
Fall injury
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
14 Fall Protection
16.14 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Equipment Washing
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Airborne particles
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
Date:
Evacuation
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Inhalation of smoke
Inhalation of chemicals / toxins
Potential death
First Aid
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
Date:
Excavator Demolition
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Crushing or asphyxiation
Inhalation of hazardous materials
Lacerations
Eye injuries
Noise
Hearing protection
Steel toed boots
Hard Hat
Safety glasses
leather gloves
Respirator
Permits
safety vest
baricades
ROPS
Fire Extinguisher
First Aid
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedstrian Traffice
22 Powered mobile equipment
33 Demolition work
Date:
Excavator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Extension Cords
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
38 Electrical Safety
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falls
Trips, Slips
electrical shocks
Eye Protection
Steel Toed Boots
Hi Visibility Vest
Spotter
Support for ladder
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 PPE
13.8 Ladders
13.11 Portable Ladders
13.14 Extension Ladders
CSA Standard CAN3-Z11-M81 (R2005)
14 Fall protection
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falls
Trips, Slips
electrical shocks
Eye Protection
Steel Toed Boots
Hi Visibility Vest
Spotter
Support for ladder
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 PPE
13.8 Ladders
13.11 Portable Ladders
13.14 Extension Ladders
CSA Standard CAN3-Z11-M81 (R2005)
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falls
Trips, Slips
electrical shocks
Eye Protection
Steel Toed Boots
Hi Visibility Vest
Spotter
Support for ladder
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 PPE
13.8 Ladders
13.11 Portable Ladders
13.14 Extension Ladders
CSA Standard CAN3-Z11-M81 (R2005)
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Burns
Inhalation of chemicals / toxins
Fire and explosion hazards
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
17.9 Welding and Allied Processes
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Hard Hat
Safety Net
Steel Toed Boots
Gloves
Safety Glasses
Fall Arrest
Travel Restraint System
Guard Rail
Fall Arrest system
Fall Arrest
Quick Retrieval System
Date:
Fire Alarm
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Inhalation of smoke
Inhalation of chemicals / toxins
Inhalation of carbon monoxide
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
13.5 Emergency Exits
19 Fire and Explosive Hazards
Date:
Fire Extinguisher
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Inhalation of smoke
Inhalation of chemicals / toxins
Inhalation of carbon monoxide
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
19.3 Fire and Explosive Hazards
Date:
Fire Fighting
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Inhalation of smoke
Inhalation of chemicals / toxins
Inhalation of carbon monoxide
Burns
Eye Protection
Face Shield
SCBA
Communication Device
1
2
3
4
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculosketal Injuries
21 Emergency Washing Facilities
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Inhalation of smoke
Inhalation of chemicals / toxins
Inhalation of carbon monoxide
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
19 Fire and Explosive Hazards
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Infection
Soreness
First Aid
Eye wash station
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
21 Emergency Washing Facilities
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falls
Trips, Slips
electrical shocks
Eye Protection
Steel Toed Boots
Hi Visibility Vest
Spotter
Support for ladder
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 PPE
13.8 Ladders
13.11 Portable Ladders
13.14 Extension Ladders
CSA Standard CAN3-Z11-M81 (R2005)
14 Fall protection
Date:
Flag Person
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Vehicle traffic
Airborne particles
Muscle strain
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
20.6 Vehicular and Pedestrian Traffic
Date:
Floor Jack
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Fall injury
Airborne particles
Vehicle malfunction
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injuries
14 Fall Protection
16 Machines, Tools and Robots
22 Powered Mobile Equipment
28.37 Scaffolds and Other Elevated Work Platforms
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle/Property damage
Other workers and equipment
Slip/Trip
Pinch points
Muscle strain
Forklift Training/Certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
8 Musculoskeletal Injuries
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Fueling Vehicles
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Eye injury
Fire/Explosion hazards
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
19 Fire and Explosive Hazards
35 Workplace Hazardous Materials Information
Systems
Date:
Function of Management
Facility:
Written By:
Hazards Present:
Approved By:
Date Created
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
Workplace Safety & Health Act
4 Duties of the employer
7.2 Duties of owners
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
Date:
Grader Operator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Gravel Checker
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Vehicle traffic
Airborne particles
Muscle strain
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
Greasing a Vehicle
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Eye injury
Burns
Potential death
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
21 Emergency Washing Facilities
35 Workplace Hazardous Materials Information
Systems
Date:
Written By:
Hazards Present:
Approved By:
Date Created
Manufacturer's specifications
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workpla
5 First Aid
6 Personal Protective Equipment
16.4 Machines, Tools and Robots Division 1
16.25 Miscellaneous Machines & Tools
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Laceration
Airborne particles
Pinch points
Slip/Trip
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
8 Musculoskeletal Injuries
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Toxic vapors
Flammable
Gloves
Breathing apparatus
Steel toed boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
35 W.H.M.I.S - Requirement, Labelling, MSDS
36 Chemical & Biological Substances
Date:
Handling Gasoline
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Toxic vapors
Flammable
Gloves
Breathing apparatus
Steel toed boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
35 W.H.M.I.S - Requirement, Labelling, MSDS
36 Chemical & Biological Substances
Date:
Oil Handling
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slips
Trips
Fires
Gloves
Breathing apparatus
Steel toed boots
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
35 W.H.M.I.S - Requirement, Labelling, MSDS
36 Chemical & Biological Substances
Date:
Handling Propane
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Muscle strain
Fire hazard
Explosion
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injuries
19.10 Compressed Gas Equipment
35 Workplace Hazardous Materials Information
Systems
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Fire/Explosion
Inhalation of chemicals / toxins
Blindness
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
19 Fire and Explosive Hazards
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle damage
Vehicle malfunction
Other workers and equipment
Airborne particles
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Hoisting
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Equipment malfunction
Muscle strain
Pinch points
Overhead wires
Permanent structures
Operator training
Flagman Procedure
Rigger Procedure
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
23 Cranes and Hoists
Date:
Written By:
Hazards Present:
Burns
Approved By:
Date Created
operator training
WHMIS
First Aid
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
22 Powered Mobile Equipment
35 WHMIS
36 Chemical & Biological Substances
41 Oil and Gas
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
Date:
Housekeeping
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Chemical exposure
Muscle strain
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
8 Musculoskeletal Injuries
35 Workplace Hazardous Materials Information
Systems
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Hydrovac Excavation
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Airborne particles
Muscle strain/Repetitive motions
Other workers and equipment
Noise pollution
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injuries
12.3 Hearing Conservation and Noise Control
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falling
Wrenches slipping
Eye Protection
Hard Hat
Steel Toe Boots
Crusher Operation
Lock out procedure
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Airborne particles
Muscle strain
Abrasions and Lacerations
Pinch points
Slip/Trip
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
Date:
Incident/Accident Response
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Potential death
Potential Injury
First Aid
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Potential fire
Inhalation of chemicals / toxins
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Inflating Tires
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Eye injury
Muscle strain
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
16.26 Miscellaneous Machines and Tools
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Equipment malfunction
Muscle strain
Pinch points
Overhead wires
Permanent structures
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
12 Hearing Coservation and Noise Control
23 Cranes and Hoists
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Equipment malfunction
Muscle strain
Pinch points
Overhead wires
Permanent structures
Operator training
Confined space
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
12 Hearing Coservation and Noise Control
23 Cranes and Hoists
26.14 Excavations & Tunnels
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Equipment malfunction
Muscle strain
Pinch points
Overhead wires
Permanent structures
Operator training
Confined space
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
12 Hearing Coservation and Noise Control
23 Cranes and Hoists
26.14 Excavations & Tunnels
Date:
Install Manholes
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Equipment malfunction
Muscle strain
Pinch points
Overhead wires
Permanent structures
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
12 Hearing Coservation and Noise Control
23 Cranes and Hoists
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Equipment malfunction
Muscle strain
Pinch points
Overhead wires
Permanent structures
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
12 Hearing Coservation and Noise Control
23 Cranes and Hoists
Date:
Written By:
Hazards Present:
Approved By:
Date Created
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.6 - 2.9 General Duties of Regulation
40(1) - 41.3(2) of the Act
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Failing vehicle
Airborne particles
Pinch points
Potential crushing hazard
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Eye injuries
Hand injuries
Noise pollution
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
16.15 Miscellaneous Machines and Tools
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Inhalation of smoke
Inhalation of chemicals / toxins
Fire/Explosion
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
16 Machines, Tools and Robots
17 Welding and Allied Processes
19 Fire and Explosive Hazards
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip hazard
Fall injury
Vehicle/Machine damage
Pinch points
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Load Excavator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip hazard
Fall injury
Vehicle/Machine damage
Pinch points
Operator training/certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Load Loader
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip hazard
Fall injury
Vehicle/Machine damage
Pinch points
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Load Skidsteer
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip hazard
Fall injury
Vehicle/Machine damage
Pinch points
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Loader Operator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Loading Excavator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip hazard
Fall injury
Vehicle/Machine damage
Pinch points
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle damage
Vehicle malfunction
Other workers and equipment
Airborne particles
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
Operator training/certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Maintenance of Scraper
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Hazards Present:
Vehicle malfunction
Vehicle damage
Approved By:
Date Created
Operator training/certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
Operator training/certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle malfunction
Vehicle damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Serious injury
Potential death
Inhalation of chemicals/toxins
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
Date:
Manual Lifting
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Muscle strain
Slip/Trip
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
8 Musculoskeletal Injuries
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Burns
Flash
Electrical shock
Inhalation of gases
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
17 Welding and allied Processes
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip hazard
Fall injury
Vehicle/Machine damage
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
16 Machines, Tools and Robots
Date:
Written By:
Hazards Present:
Forceful Exertion
Repetitive stress
Muscle strain
Limited mobility
Akward Position
Vibration
Mechanical Compression
1
2
Approved By:
Date Created
MSI training
PPE training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculoskeletal Injury
Date:
Oil Changing
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Injury by machine rolling
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
35 WHMIS
Date:
Oil - Hydraulic
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Chemical burn
Inhalation of chemicals/toxins
Eye injury
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
21 Emergency Washing Facilities
35 WHMIS
36 Chemical and Biological Substances
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
16 Machines, Tools and Robots
Date:
Perimeter Fencing
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
WSH Act 2.4 and 2.18
20.4 Vehicular & Pedestrian Traffic
26.12 Guarding Excavations
Date:
Pneumatic Ratchet
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
pinch points
flying debris
excessive noise
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
16 Machines. Tools and Robots
Date:
Portable Generator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Manufacturer's manual
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Noise
Airborne particles
Tripping
Explosion of tank or air line
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
12.3 Hearing Protection
16.4 Machine and Tool Safety
19.10 Fire and Explosion Hazards
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Electrocution
Slip/Trip
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment\
38.10 Electrical Safety
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Eye injuries
Hand injuries
Airborne particles
Noise pollution
Electricution
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
16.25 Miscellaneous Machines and Tools
Date:
Power Tools
Facility:
Written By:
Hazards Present:
Approved By:
Date Created
Manufacturer's specifications
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workpla
5 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots Division 1
16.22-16.28 Miscellaneous Machines & Tools
Date:
Written By:
Hazards Present:
Slips, Trips and Falls
Traffic
Approved By:
Date Created
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
The Workplace Safety & Health Act W210
2.4 Inspections of Workplace
5 Duties of Workers
6 Personal Protective Equipment
12 Hearing Conservation & Noise Control
Cumming & Dobbie Inspection Policy
Date:
Written By:
Hazards Present:
Approved By:
Date Created
Safety Glasses
Care of
Use of
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6.13 Personal Protective Equipment
CSA Standard Z94.3-02
CSA Standard Z94.3.1-02
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Foot injury
Ankle injury
Corrosive chemicals
Care of
Use of
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6.12 Footwear - PPE
CSA Standard Z195.1-02
CSA Standard Z195-02
Date:
Written By:
Hazards Present:
Approved By:
Date Created
Hard Hat
Care of
Use of
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6.10 Personal Protective Equipment
CSA Standard Z94.1-05
ANSI Z89.1-2003
Date:
Written By:
Hazards Present:
Approved By:
Date Created
Ear Plugs
Ear Muffs
Care of
Use of
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
12 Hearing Conservation & Noise Control
CSA Standard Z94.2-02
Date:
Written By:
Hazards Present:
Approved By:
Date Created
Care of
Use of
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6.7 Personal Protective Equipment
CSA Standard Z96-02
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Radiant heat
sharp objects
jagged objects
punctures
Abrade the skin
Care of
Use of
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6.8 Protective clothing
6.9 Protective Clothing
CSA-W117.2-01 (R2006)
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Poisionous gases/Chemicals
Lack of Oxygen
Respirators
Care of
Use of
Selection of
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6.15 Personal Protective Equipment
CSA Standard Z94.4-02
CSA Standard Z180.1-00
35 Workplace Hazardous Materials Information System
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Crushing
Wrenches slipping
Tire explosion
Gloves
Safety Glasses
Steel toed Boots
Rim flange and bead seats must be clean and dust off foreign material. Remove with wire brush or emery cloth
Any visible dent in rim flanges should be straightened with a hammer.
Any hammer dents should be smoothed out with a file
Inspect weld of rim. Grooves or high spots in bead area must be filed flat and smooth or the tire assembly
may loose air
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
8 Musculosketal Injuries
15 Confined Spaces
22 Powered Mobile Equipment
Date:
Propane Heaters
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Fumes/Exhaust
Flammable materials
Tripping hazard
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
35 WHMIS
36 Chemcial and Biological Substances
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Asphixiation
Fall Injuries
Muscle strain
Loose grounding
Rigging
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
12 Hearing Conservation and Noise Control
26.15-26.32 Excavations and Tunnels
Written By:
Approved By:
Date Created
Hazards Present:
Asphixiation
Fall Injuries
Muscle strain
Loose grounding
Rigging
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
12 Hearing Conservation and Noise Control
26.15-26.32 Excavations and Tunnels
Pumping Water
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Tool damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Eye injuries
Hand injuries
Airborne particles
Noise pollution
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
16 Machines, Tools and Robots
16.15 Miscellaneous Machines and Tools
Date:
Repairing Equipment
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Pinch points
Lacerations
Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Equipment failure
Collision
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
35 Workplace Hazardous Materials Information
Systems
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Operator training
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Slip/Trip
Vehicle damage/malfunction
Steel toed
Eye protection
Hand protection
Hard hat
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falling
Wrenches slipping
Eye Protection
Hard Hat
Steel Toe Boots
Crusher Operation
Lock out procedure
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falling
Wrenches slipping
Eye Protection
Hard Hat
Steel Toe Boots
Crusher Operation
Lock out procedure
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Written By:
Hazards Present:
Approved By:
Date Created
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
WSH Act W210 Section 7.4(5)(b)
WSH Regulation M.R. 217/2006 Section 2.1
Safe Work Bulletin 249 1 of 3
Safe Work Bulletin 249 2 of 3
Safe Work Bulletin 249 3 of 3
Date:
Safeguards
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Lacerations
Amputation
Pinching
Eye Protection
Hand Protection
Hard Hat
Manufacturer's specifications
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
16.5 Safeguard Requirements
16.7 Removing a safeguard
22.5 Guarding Moving Parts
16.19 Additional Safeguards for conveyors
Date:
Scaffold
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Fall injuries
Slip/Trip
Pinch points
Workers overhead/below
Scaffold training
Fall Training
First Aid
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
6 Personal Protective Equipment
28 Scaffolds and Other Elevated Work Platforms
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Pinch points
Loss of limb
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Pinch points
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip
Pinch points
Vehicle damage
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
16 Machines, Tools and Robots
20 Vehicular and Pedestrian Traffic
22.32 Powered Mobile Equipment
Date:
Serious Injury
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Potential death
Loss of limb
Infection
First Aid
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
5 First Aid
Date:
Set Clutch
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
Date:
Set up Conveyor
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falling
Wrenches slipping
Eye Protection
Hard Hat
Steel Toe Boots
Crusher Operation
Lock out procedure
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Set up - Crusher
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch Points
Falling
Wrenches slipping
Slips / Trips
Lifting manually
Fire Extinguisher
Eye Protection
Hard Hat
Steel Toe Boots
Snug fitting clothes
Protective mask or respirator
Hearing Protection
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Preotective Equipment
14 Fall Protection
15 Confined Spaces
16 Machines, tools and Robots
22 Powered Mobile Equipment
28 Scaffolds & Other Elevated Work Platforms
30 Temporary Structures
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slips/trips
Vehicular traffic
Muscle strains
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
20 Vehiculat and Pedestrian Traffic
Date:
Setting Brake
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Vehicle/property damage
Serious injury
Pinch points
S endorsement on license
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirments
16 Machines, Tools and Robots
Date:
Shoveling Granular
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Muscle Cramps
Heart attack
Stroke
Dehydration
Lifting
Body Posture
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
8 Musculoskeletal Injuries
Date:
Shoveling Snow
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Muscle Cramps
Heart attack
Stroke
Dehydration
Frost Bite
Lifting
Body Posture
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
8 Musculoskeletal Injuries
Date:
Site Inspections
Facility:
Written By:
Hazards Present:
Approved By:
Date Created
Hard Hat
Steel toed boots
Eye protection
Hand protection
Hearing Protection
High visibility vest
Slips/Trips/Falls
Serious injury
Traffic
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.4 Inspections of Workplace
5 Duties of Workers
6 Personal Protective Equipment
12 Hearing Conservation & Noise Control
Date:
Skidsteer Operation
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machies, Tools and Robots
20 Vehicular and Pedestrian Traffic
22 Powered Mobile Equipment
Date:
Snow Blower
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
Date:
Solvent Recycling
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
pinch points
fire
explosions
splashing
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
16 Machines. Tools and Robots
35 WHMIS
36 Chemical and Biological Substances
Date:
Spill Containment
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Chemical Inhalation
Serious injury
Chemical Burns
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
35 Workplace Hazardous Materials Information System
36 Chemical and Biological Substances
Date:
Starting Chainsaw
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Amputation
Personal Injury
Projectiles
Bodily strains
Noise
First Aid
Chainsaw Training/ Certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
5 First Aid
6 Personal Protective Equipment
8 Musculoskeletal Injuries
12 Hearing Conservation and Noise Control
16.27 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Sun Protection
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Sun burn
Skin cancer
Inflammation - cornea cataracts
Blindness
Long sleeves
Steel toed boots
Eye protection
Hand protection
Hard Hat
SPF
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
22 Powered Mobile Equipment
Safe Work Bulletin #148
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Slip/Trip hazard
Fall injury
Vehicle/Machine damage
Pinch points
Operator training/certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machines, Tools and Robots
22 Powered Mobile Equipment
Date:
Time Management
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
MSI injuries
Repetitive Motions
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
Safe Work Bulletin #246
4 General Workplace Requirements
8 Musculoskeletal Injuries
16 Machies, Tools and Robots
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Crushing or asphyxiation
Inhalation of hazardous materials
Lacerations
Eye injuries
Noise
Hearing protection
Steel toed boots
Hard Hat
Safety glasses
leather gloves
Respirator
Permits
safety vest
baricades
ROPS
Fire Extinguisher
First Aid
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
20 Vehicular and Pedstrian Traffice
22 Powered mobile equipment
33 Demolition work
Date:
Tube Flaring
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
pinch points
lacerations
Operator training
First Aid
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
22 Powered Mobile Equipment
Date:
Unloading Excavator
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
16 Machies, Tools and Robots
22 Powered Mobile Equipment
Date:
Unloading Granular
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
16 Machies, Tools and Robots
22 Powered Mobile Equipment
Date:
Unloading Loader
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
22 Powered Mobile Equipment
Date:
Unloading Skidsteer
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
22 Powered Mobile Equipment
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Pinch points
Chemical fumes
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
6 Personal Protective Equipment
16 Machines, Tools and Robots
35 WHMIS
Date:
Utility Locations/Clearances
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
Date:
Utility Locations/Clearances
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
Date:
Welding
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Burns
Flash
Inhalation of gases
Electrical shock
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
17 Welding and Allied Processes
Date:
Working Alone
Facility:
Written By:
Approved By:
Date Created
Hazards Present:
Slips or Trips
Serious injury
Pinch points
First Aid
Equipment Training/Certification
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
6 Personal Protective Equipment
9 Working Alone or in Isolation
Date:
Written By:
Approved By:
Date Created
Hazards Present:
Muscle strains
Serious injury
Pinch points/Crushing
If an emergency situation occurs while conducting this task, or there is an equipment malfunction, engage
the emergency stop and follow the lock out procedure
REPORT ANY HAZARDOUS SITUATIONS TO YOUR SUPERVISOR
Guidance Documents/Standards:
MB Workplace Safety & Health Act & Regulations:
2.1 Safe Work Procedures
4 General Workplace Requirements
6 Personal Protective Equipment
16 Machies, Tools and Robots
??? Lock out
Date: