Check all applicable hazards that may be present before or during the task(s)
PERMITS EMERGENCY EQUIPMENT BIO-HAZARDS EQUIPMENT
Hot Work Fire extinguisher Sharps/Bio-Hazard Operating power equipment Confined Space Eyewash Animal Droppings Operating lifts Lockout Other Equipment as required Mould/Asbestos Power tools WHMIS IS WORKER WORKING ALONE First aid kit Hand Tools (Knives/saws, etc.) MSDS reviewed No Spill Potential Spill kit Equipment/Tool inspection Yes Someone informed Work Alone Procedures apply ERGONOMIC ENVIRONMENT PERSONAL PROTECTIVE EQUIPMENT OVERHEAD/WORKING AT HEIGHTS Manual Lifting Weather conditions Work gloves Harness required Too heavy/awkward Hazardous waste Chemical gloves Appropriate tie-off IDd Over-reaching Limited access/egress Rain gear Others working above/below Prolonged/extreme bending Exposure to energized electrical Rubber boots Falls from height Repetition Lighting level too high/low Monogoggles/Faceshield Hoisting/moving loads overheard Unstable position Exposure to share Safety goggles Use of scaffolds objects/edges ingers/hands pinch points Noise Suitable respiratory mask Working above your head Hands not in line of sight Fumes/vapours Hearing protection Objects/debris falling Working in tight clearances Extreme heat/cold Safety harness/lanyard Physical limitation/need help Reactive chemicals Head protection Steam Hi-vis vest Adequate ventilation Fire retardant wear Housekeeping Other: Dust Click here to enter text if other is selected. Once you have written all tasks and hazards, complete the third column identifying all plans to eliminate/control hazards. IT IS IMPORTANT THAT ALL HAZARDS HAVE PLANS TO ELIMINATE/CONTROL THEM AND THAT THE PLANS ARE PUT INTO PLACE. TASK(S) HAZARDS PLANS TO ELIMINATE/CONTROL RISK Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.
ALL MEMBERS OF THE CREW MUST SIGN PRIOR TO COMMENCING WORK AT THE TASK LOCATION.