eHazard Assessment
Site Specific or Field Level
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Name
*
Danny Finn
Eric Scott-Iversen
Ethan Early
Greg Skeavington
Keith Mc Cabe
Mel Heyd
Theo van Zyl
Enter Name if not listed
Your Email
example@example.com
Work Site
*
Muster Point
Work Crew Count
*
Including person completing hazard assessment
Work Crew Names
Danny Finn
Eric Scott-Iversen
Ethan Early
Greg Skeavington
Keith Mc Cabe
Mel Heyd
Theo van Zyl
Other
Work Crew Names OLD
Climber's Designated Groundy
Site Supervisor
Danny Finn
Eric Scott-Iversen
Greg Skeavington
Theo van Zyl
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 a nest inspection been carried out?
Yes
No
N/A
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 operating powered mobile equipment?
*
Yes
No
2.1 What Physical Hazards have you identified
*
Sharp blades / chainsaws
Noise
Chipper Feed Chute
Slips, Trips and Falls
Overhead power lines
Falling Objects
Broken tops
Hung up limbs
Heavy Lifting
Extreme temperatures
High winds
Storm risk/ Lightening
Sparks
Dust
Repetitive Motions
Poor Visibility
Wildlife
Pressurised Materials
Working around Equipment
Working at Heights
Working around other trades
Traffic
Violence
Other
2.2. What Constant Hazards have you identified
N/A
Chipper
Climber/ Groundy sharing drop zone
Climbing above 3 meters
Hydraulic machines
Noise from chainsaw
Public/ Homeowner
Working in the drop zone
Other
2.2. What Biological/Chemical Hazards have you identified
*
N/A
Animal/Pet Waste
Insects
Sewage
Hazardous Fumes/Gases
Hazardous Liquids
Other
2.3. What Psychological Hazards have you identified
*
N/A
First time performing the task
Harassment / Bullying
Mental/physical fatigue
Process Change
Stress
Time Pressure
Uncertain of method/tool to be used
Other
3. Controls
3.1. Engineering Controls
*
N/A
Use barricades to limit access
Use equipment guards
Use hoists or equip to lift heavy loads
Chipper Reverse Bar
Use MEWP for Access
Other
3.2. Administrative Controls
*
N/A
Ask for assistance or explanation if needed
Be familiar with work limits for powerlines
Designate one Groundy for communications if needed
Keep work area tidy
Place drop zone cones around Drop zone
Preform a site survey for overhead hazards prior to work
Provide training for workers
Review SDS
Rotate jobs with co-workers
Take scheduled breaks
Use Safe Job Procedure/Work Practice
Use SENA comms devices
Other
3.3. PPE Controls
*
N/A
Approved Footwear
Coveralls
Face Shield
Fall Protection Equipment
Gloves
Hard Hats
Hearing Protection
Masks / Respirators
Reflective Hi-Vis Clothing
Safety Glasses
Other
Add Images
Take a Picture
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Work Crew Signature #2
*
Work Crew Signature #3
*
Work Crew Signature #4
*
Work Crew Signature #5
*
Work Crew Signature #6
*
Work Crew Signature #7
*
Work Crew Signature #8
*
Work Crew Signature #9
*
Work Crew Signature #10
*
Back
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Next
Reassessment
Revised Time
AM
PM
AM/PM Option
Revised Time
Newly Identified Hazards
Additional Controls
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