eHazard Assessment
Site Specific and Field Level Hazard Assessments
Your Name
*
Curtis Scherer
Connor Goodfellow
Futa Todoroki
Scott Cranston
Other
Your Email
example@example.com
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Job Site
*
Cairo
Distinctive Homes
High Point - Ascent
High Point - Cascade
Mountainside
Other Closets
Other Garages
SCMV - Blackswift
SCMV - Mountain Lynx
SCMV - TMV 900
SCMV - TMV 1000
Enter Job Site if not listed above
Job Site Address
Who are you completing this SSeHA for?
Just Myself
Our Work Crew
How Many in your Work Crew?
Including yourself
Enter Names of Work Crew
Foreman
Weather Conditions
Clear/Sunny
Cloudy
Wind
Rain
Lightening / Thunderstorm
Freezing Rain
Snow
Fog
Smoke/Haze
Expected Temperature for Today
Please Select
HOT (above +20C)
WARM (+11 to +20C)
COOL (0 to +10C)
CHILLY (0 to -10C)
COLD (-11 to -20C)
EXTREME COLD (below -20C)
Has the PPE been inspected?
*
Yes
No
Has pre-inspection of Tools/Equipment been completed?
*
Yes
No
Was a pre-trip inspection of your vehicle been completed before driving?
*
Yes
No
Did you have a Toolbox Talk this week?
Yes
No
Are you working alone?
Yes
No
Explain your working alone control procedures
*
Always keep phone charged and within reach
Call/text to supervisor twice per day
Communicate/check in with other work crews on site
1. Tasks
Type of Work
*
Closets
Garage
Closet Tasks
*
Transfer material onto site
Locate studs and be aware of utilities
Install extension boxes on receptacles, light switches
Secure hardware to walls
Measure and cut wood
Assemble and install systems
Clean up work area
Other
Garage Tasks
*
Transfer material onto site
Locate studs and joists
Secure hardware to walls and ceilings as required
Assemble and install garage products - drilling and fastening
Install extension boxes on receptacles, light switches
Cutting slat wall panels
Clean up work area
Other
2. Hazards
Consider the four contributing factors to hazards – P. E. M. E.
People
– are they competent/well trained? Are they tired? What motivates them?
Equipment
– Is it appropriate for the task? Is it properly installed and maintained? Are manufacturers specs being followed?
Materials
– What materials are being used? Are they being handled, stored and disposed of properly?
Environment
– Where is the task being performed? Does the work site environment introduce hazards?
Are you working at height today?
Yes
No
Do you need to complete a fall protection plan?
Yes
No
Are you doing any hot work today?
*
Yes
No
Have you completed and submitted a hot work permit?
Yes
No
Are you using Powered Mobile Equipment?
Yes
No
2.1 What Physical Hazards have you identified
*
N/A
Awkward Loads
Cluttered Workspace
Dust
Electrical Box Extensions
Extreme Temperatures
Falling Objects
Flying debris
Heavy Lifting
Noise
Poor Ergonomics
Poor Lighting
Powered Tools
Repetitive Motions
Saw blades / drill bits / Exacto Knives
Slips, Trips and Falls
Vibration
Violence
Weather
Wildlife
Working around other trades on site
Working around PME
Working at Heights/ladders
Other
2.2. What Chemical Hazards have you identified
*
N/A
Hazardous Paints/Lacquers
Hazardous Liquids
Spills
Vehicle Exhaust
Other
2.3. What Biological Hazards have you identified
*
N/A
Animal/Pet Waste
Insects
Moulds/Fungi
COVID 19
Sewage
Other
2.4. What Psychological Hazards have you identified
*
N/A
Fatigue
Harassment / Bullying
Process Change
Shift Work
Stress
Time Pressure
Other
3. Controls
3.1. Engineering Controls
*
N/A
Insulate to reduce excessive noise
Set up lighting / use headlamps
Set up ventilation
Substitute hazardous chemicals for something less toxic
Use barricades to limit access
Use equipment guards
Use hoists or equip to lift heavy loads
Use scaffolding/ladders
Vaccination
Other
3.2. Administrative Controls
*
N/A
Continue to use caution even when taped.
DO NOT TOUCH +ve or -ve connections if breaker is still ON.
Inspect Equipment
Keep work area tidy
Limit Exposure times
Physical Distancing
Provide training for workers
Remove clutter from work area
Review SDS
Shut off breaker if accessible
Use caution when removing switch or receptacle from box
Use Safe Job Procedure/Work Practice
Use sanitiser
Wrap switch or receptacle with electrical tape to insulate connections if breaker is still ON
Other
3.3. PPE Controls
*
N/A
Approved Footwear
Coveralls
Fall Protection Equipment
Gloves
Hard Hats
Hearing Protection
Masks / Respirators
Reflective Hi-Vis Clothing
Safety Glasses
Other
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Take a Picture
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Choose a file
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of
Work Crew
You are confirming that the work crew entered above have been involved in completing this Site Specific eHazard Assessment, and all are fully aware of the hazards and understand the controls implemented.
Signature
*
Work Crew Signature #1
Work Crew Signature #2
Work Crew Signature #3
Work Crew Signature #4
Back
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Next
Reassessment
Revised Time
AM
PM
AM/PM Option
Revised Time
Newly Identified Hazards
Additional Controls
Submit
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