Introduction to Hazard & Risk Management eLearning

Sample Hazard Analysis Checklist Location_________________________________________________

1. Task Analysis Hazard and Risk Review 3. Training Y NA 5. Hazard Control

Date: ________________________________ Fall protection   Eyes:  Eye wash
Company: ____________________________ WHMIS    Glasses/goggle  Face shield
Employee: ____________________________ First Aid   Ears:  Plugs/muffs
Foreman: _____________________________ Powerline awareness   Body:
Job Location: __________________________ Fire extinguisher    Boots  Hard hat
2. Pre-Job Evaluation Y NA Elevated work platform    Fire retardant  Gloves
Job scope understood   Traffic control   Traffic vest  Chaps
Orientation completed   TDG    Welding helmet  Knee pads
Safety equipment available   Forklift   Elevation:  Guardrails
Proper tools available for task   Explosive Actuated tools    Fall protection  Scaffolding
All isolation points identified   Other training:    Overhead prot.  Signage
MSDSs available   ___________________   Environment:
Job procedures reviewed   ___________________    Job rotation  Lighting
Environmental impact review   ___________________    Ventilation  Water
Permits required 4. Potential Hazards Housekeeping:
 Safe work   Eyes:  Particle  Clear work area  Clean up
 Hot work   Ears: Loud noise Fire:
 Confined spaces   Respiratory: Inhalation  Extinguisher  Grounding
 Energized electrical   Body:  UV protection  Fire watch
 Underground    Cuts, sharp edges Additional Controls:
 Waste disposal    Repetitive motion  Proper equipment for task
 Critical lifting    Pinch point  Guards on moving parts
 Other    Overexertion  Tag and lockout required
Housekeeping reviewed    Pressure test and isolation
 Awkward posture
Weather conditions considered  Engineered trench box
   Vibration
PPE requirements reviewed  Utility locates
  Elevation
Inspection checklists complete  Hazard signage
Overhead hazards identified    Falling material
   Overhead work  Communication devices
Excavation hazards reviewed  Material handling equipment
Traffic control plan reviewed    Elevated work
 Shoring or cutbacks
Open holes secured   Environment
 Proper cranes
Slips, trips, falls assessed    Cold stress
 Proper rigging and tag lines
Proper equipment reviewed    Heat stress  Potable water
Lockout reviewed    Poor access/egress Other:
Fire plan reviewed    Inadequate lighting  _________________________
Flammable storage reviewed    Inadequate ventilation  _________________________
Emergency plan reviewed    Weather conditions  _________________________
Other:   Housekeeping  _________________________
________________________    Debris, material, tools  _________________________
________________________   Equipment  _________________________
________________________    Reversing equipment  _________________________
   Moving equipment  _________________________
 Cranes
IF A MORE SPECIFIC JOB/TASK RISK ANALYSIS IS REQUIRED FILL IN BELOW
JOB HAZARDS CONTROL HAZARD CONTROLLED?

Worker Name Signature Worker Name Signature

Supervisor Name ________________________ Signature: ________________________________ Date : _______________