eHazard Assessment
Site Specific or Field Level
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Date
-
Month
-
Day
Year
Date
Hour Minutes
Name
Brian Williams
Christopher McKenzie
Clinton Whelan
Jeremy Baker
Linda Lemery
Michael Mackeprang
Oliver Nutt
Trevor Soltys
Enter Name if not listed
Your Email
*
example@example.com
Job Site
*
Landfill
T.O.B.
Muster Point
Site Supervisor
Andrew Calder
Brian Williams
Linda Lemery
Liz Boak
Trevor Soltys
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)
Road Conditions
Wet
Slippery
Snowy
Ice
Dry
Dusty
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?
*
Yes
No
Toolbox Topic
Inspection or Incident review
Toolbox Action Items
Are you working alone?
Yes
No
Explain your working alone control procedures
*
1. Phone/check in with supervisor every 30 mins
2. Communicate/check in with other work crews on site
3. Explain Other Method
1. Tasks
1. List all Tasks to complete the job today
*
(steps to complete the job)
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 above 3 metres today?
*
Yes
No
Are you protected by guardrails?
*
Yes
No
Are you wearing a harness today?
*
Yes
No
Have you completed a fall protection plan for this specific work?
Yes
No
Explain why fall protection plan is not required
Are you doing any hot work today?
*
Yes
No
Have you completed and submitted a hot work permit?
Yes
No
Are you operating powered mobile equipment?
*
Yes
No
2.1 What Physical Hazards have you identified
*
N/A
Awkward Loads
Confined Space
Dust
Falling Objects
Flying debris
Heavy Lifting
Other trades/workers
Overhead Electrical Lines
Poor Ergonomics
Poor Lighting
Powered Mobile Equipment/Traffic
Powered Tools
Repetitive Motions
Sharp blades / drill bits
Slips, Trips and Falls
Sparks
Using Ladders
Violence
Weather
Wildlife
Working at Heights
Other
2.2. What Chemical Hazards have you identified
*
N/A
Hazardous Fumes/Gases
Hazardous Liquids
Spills
Vehicle Exhaust
Other
2.3. What Biological Hazards have you identified
*
N/A
Animal/Pet Waste
Insects
Moulds/Fungi
Pandemic/Sickness
Sewage
Other
2.4. What Psychological Hazards have you identified
*
N/A
Fatigue
Harassment / Bullying
Process Change
Shift Work
Stress
Time Pressure
Other
2.5. What Energy Hazards have you identified
*
N/A
Chemical Hazards (explosives/flammables)
Energized Electrical System
Hydraulic (Compressed Fluids)
Mechanical (moving machinery parts)
Mechanical (parts under tension/raised)
Pneumatic (Compressed Air)
Temperature (Hot/Cold - water,steam etc)
Vibration (Equipment or Noise >85dB)
Other
3. Controls
3.1. Engineering Controls
*
N/A
Barricade to limit access
Equipment guards used
Insulate to reduce excessive noise
Isolate from Energy Source
Lighting
Scaffolding
Substitute chemicals for something less toxic
Use hoists or equip to lift heavy loads
Ventilation
Other
3.2. Administrative Controls
*
N/A
Hot Work Permit
Inspect Equipment
Limit Exposure times
Lockout/Tagout
Physical Distancing
Safe Job Procedure/Work Practice
Safety Data Sheets
Switch out with team members
Tidy work area
Training for workers
Vaccination
Work Breaks Regularly
Work Scheduling
Other
3.3. PPE Controls
*
N/A
Approved Footwear
Coveralls
Fall Protection Equipment
Gloves
Hand Sanitiser
Hard Hats
Hearing Protection
Masks / Respirators
Reflective Hi-Vis Clothing
Safety Glasses
Other
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Signature
*
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Next
Reassessment
Revised Time
AM
PM
AM/PM Option
Revised Time
Newly Identified Hazards
Additional Controls
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