eHazard Assessment
Site Specific or Field Level
Date
*
 -
Month
 -
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Name
*
First and Last Name
Your Email
*
example@example.com
Your Company
*
Work Site
*
McHardy Residences, Banff
Natures Edge
Site Address if not listed above
Jobsite Address
Muster Point
Who are you completing this eHA for?
Just Myself
Our Work Crew
How Many in your Work Crew?
Enter Names of Work Crew
Site Supervisor
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?
*
Yes
No
Toolbox Topic
Toolbox Highlights
e.g. Main points discussed, Inspection or Incident review etc.
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 working off a ladder or 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
Dust
Falling Objects
Flying debris
Heavy Lifting
Limited Access/Egress
Pinch Points
Poor Ergonomics
Poor Lighting
Powered Mobile Equipment
Powered Tools
Repetitive Motions
Sharp blades / drill bits
Slips, Trips and Falls
Trades/Workers
Underground/excavation/wells
Violence
Weather
Wildlife
Working at Heights
Other
2.2. What Chemical Hazards have you identified
*
N/A
Aerosols
Cleaning Products
Flammables
Hazardous Fumes/Gases
Hazardous Liquids
Natural Gas
Paints
Propane
SDS Not Available
Smoke
Spills
Vehicle Exhaust
Volitile Organic Compounds (VOC's)
Other
2.3. What Biological Hazards have you identified
*
N/A
Animal/Pet Waste
Asbestos
Bodily Fluids
Insects
Lead
Moulds/Fungi
Pandemic/Sickness
Pesticides
Radioactive Materials
Sewage
Silica
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
Electrical
Hydraulic (Compressed Fluids)
Mechanical (moving machinery parts)
Mechanical (parts under tension/raised)
Pneumatic (Compressed Air)
Temperature (Heat/Cold)
Vibration (Equipment or Noise)
Other
3. Controls
3.1. Engineering Controls
*
N/A
Barricade to limit access
Guards on Equipment
Hoarding
Hoists or equip to lift heavy loads
Insulate to reduce excessive noise
Isolate from Energy Source
Lighting
Scaffolding
Substitute chemicals for something less toxic
Ventilation
Other
3.2. Administrative Controls
*
N/A
3 points of contact
Be aware
Eye contact with driver
Haz Mat Survey Conducted
Hot Work Permit
Inspect Equipment
Inspector Sign-Off
Keep work area tidy
Limit Exposure times
Lock out / Tag out
Physical Distancing
Review SDS
Safe Job Procedure/Work Practice
Switch out with team members
Tidy work area
Training for workers
Use a spotter
Warning signs/cones
Work Breaks Regularly
Other
3.3. PPE Controls
*
N/A
Approved Footwear
Coveralls
Fall Protection Equipment
Gloves
Hard Hats
Hearing Protection
Masks
Reflective Hi-Vis Clothing
Respirators
Safety Glasses
Tyvek Suit
Other
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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
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Reassessment
Revised Time
AM
PM
AM/PM Option
Revised Time
Newly Identified Hazards
Additional Controls
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