Task/Work Steps for the Week Identify Specific Hazards Identify Controls Control Risk

Rating

Initials Initials Initials

Date of Reassessment: Date of Reassessment: Date of Reassessment:
Describe Changes: Describe Changes: Describe Changes:

RISK RATING
“Red” High (1) These risks are not acceptable for our organization. While risk measures can be put into place (Elimination, Engineering, Administration and PPE) the job should be stopped in till proper people (i.e. the safety
department, management) can be brought in to maintain and control the risk, which will allow us to bring it to a tolerable and acceptable level of risk for all involved.
“Yellow” Medium (2) Working with Medium risk, while we need to take into account that the risks can be lowered to a tolerable level, effort to do this must be taken before starting the task. These risks are said to happen 20%-50% of
the time when doing the particular task, though still considered an infrequent event. Control Methods must be put in place
“Green” Low (3) These risks would be considered acceptable, with no actions required. While no actions are required, a reassessment of the task is mandatory whenever something changes within the scope. These risks would be
a first aid injury that does not require medical attention, though it is considered an unlikely event.
Probability Impact
1. Serious/ Imminent Danger – fatality, loss of facility, widespread occupational a. Probable – likely to occur immediately or soon
illness
2. Moderate – injury/illness, property/equipment damage b. Reasonable Probable – likely to occur eventually

3. Minor – non-serious injury, illness or damage c. Remote – could occur at some point
 Field Level Hazard Assessment
DATE:
LOCATION: High Risk Potential Hazards EQUIPMENT INSPECTION
General Hazards □ N/A -Is the skidsteer clean and orderly?
□ Confined/Restricted Space YES / NO
□ Balance, Traction, Grip (slips, trips, falls) -Is there a first aid kit and fire extinguisher?
□ Lock-out/Tag-out/Energy Isolation
□ Congested Work Area □ Hot Work
YES / NO
-Are the fluid levels correct (fuel, engine oil, coolant)?
□ Electrical Hazards (overhead power lines, □ Working at Heights YES / NO / NA
mechanical rooms, etc) □ Other: -Are there any loose or missing parts?
□ Ergonomics (awkward body position, tight YES / NO / NA
Type of Fall Protection Used: -Are the tire and wheels in good condition?
area, twisting, bending)
□ N/A YES / NO
□ Exposure/Hazardous Atmosphere (dust, *Valid OSSA Fall Protection Required* -Are all lights in working order?
fumes, vapor, chemicals, etc...) □ 5 – Point Full Body Harness YES / NO
- Is there anything you need to add in regards to the equipment being
□ Extreme Weather/Temperature (hot, cold, □ 6’ Double Y Lanyard
used?
rain, hail, etc...) □ Self-Retractable Lanyard
□ Dog Leash/Collar
□ Eye Hazards □ Fall Protection Plan Written and On Site
□ Falling Objects FALL CALCULATION Signage
□ Fire Hazards Lanyard: 6’
Are the signs in the upright position: YES / NO
□ First Time Performing Task
Deceleration: 3.5
□ Hand/Power Tools Is there an ERP fully filled out on the back of the sign?: YES / NO
□ Hot/Cold Surfaces (burns, frostbite) Average Height: 6’ Working Alone
□ Housekeeping -Is the employee working alone?
□ Impact to Environment/Waste Manage. Safety Factor: 3’ YES / NO
-If yes, please explain what steps to improve the hazardous situation.
(garbage, spills, waste storage)
Total: 18.5’
□ Knife use/Cutting Material
□ Ladders
□ Manual Lifting/Hoisting/Lowering (muscle
END OF SHIFT
strain) Pre-Use Inspections Completed - Was all the area cleaned up at the end of job/shift?
□ Material Placement/Storage □ Hand / Power Tools / Electrical Cords YES / NO
□ Noise □ Equipment / Material (vehicles, ladders, etc…) - Are there Hazards remaining?
□ PPE (harness, lanyard, boots, gloves, glasses) YES / NO
□ Other Workers *Any Equipment/Material that has damage must be properly - Were there any incidents/injuries?
□ Personal Limitations (medical, physical, identified/removed from service and reported to your YES / NO
mental) supervisor* -If Yes, Please Explain:
□ Rotating Equipment Machinery Were you hurt at work today? Date and Sign if NO. If yes
explain in section on right side of page
□ Sharp Edges/Pinch Points/Crush Points
Date: Signature:
□ Stored/Pressurized Equipment (traffic or
operation)
□ Visibility Lighting
□ Wildlife
□ Working Above/Below Others
□ Working Alone Reviewed By:
□ Working at Heights Date: