FIELD LEVEL HAZARD ASSESSMENT
OHS COMPLIANCE · CONSTRUCTION SAFETY
FORM #04-02 | REV. 01
FIELD LEVEL HAZARD ASSESSMENT
RISK MATRIX
| Probability \ Severity | Minor (1) | Moderate (2) | Serious (3) | Critical (4) |
|---|---|---|---|---|
| Very Likely (4) | Medium | High | Critical | Critical |
| Likely (3) | Low | Medium | High | Critical |
| Unlikely (2) | Low | Low | Medium | High |
| Rare (1) | Low | Low | Low | Medium |
TASK ANALYSIS
| Task Steps (1) | Hazards (2) | Initial Risk (3) | Control Measures (4) | Residual Risk (5) |
|---|---|---|---|---|
PRE-USE INSPECTION
Pre-use Inspection done for:
PPE (Hard Hat / Safety Boots / Hi-vis Vest)
Specialized PPE (Fall Pro/Respirator/Face shield etc)
Tools & Equipment for the job at hand
Other:
Exclusion Zones/Public Safety
Work areas/zones/levels barricaded i.e. danger tape
Surrounding trades notified (Warning Sign posted)
Objects (materials, tools & equipment) are tethered
Traffic Control Layout/Plan implemented
Applicable SWP/SJP Reviewed for the job?
PERMITS & CRITICAL TASKS
Confined Space:
Hazardous Products Exposure Control Plans & SDS:
Leading Edge:
Silica Dust Exposure Control Plan:
Hot Work:
Fall Protection Plan (If above 25ft):
Ventilation Plan:
Other:
Other:
AFTER JOB/SHIFT END
Any new hazards introduced as a result?
Are such hazards controlled/communicated?
If "No", reassess on first page
By signing below, I acknowledge that I have reviewed this hazard assessment and the procedures to control the hazards with my supervisor and I understand my responsibilities.
WORKER SIGN-OFF
Add Worker Not in Database
All workers must print name and sign below:
Crew Supervisor:
Signature:
Not selected
THIS ASSESSMENT VALID FOR ONE SHIFT ONLY
