eHazard Assessment
Site Specific and Field Level Hazard Assessments
Your Name
Your Email
example@example.com
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Work Site
*
3rd Street - Findlay
515 Montclair Cochrane
8th & 8th
Banff Gondola Distribution Upgrade -Upper/Lower Terminal
Banff Park Lodge
Brookside
Cascade Plaza
Cascade Plaza Distribution Upgrade
Devonian - Meadows
Gateway
Pursuit Banff Transit Depot
Rimrock Resort Hotel
Spring Bank HSS
YMCA
Add site name if not listed above
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
Site Superintendent
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
*
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 or working off a ladder?
*
Yes
No
Are you wearing a harness?
*
Yes
No
Have you completed a fall protection plan for this specific work?
*
Yes
No
Are you doing any hot work today?
*
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
Poor Ergonomics
Poor Lighting
Powered Mobile Equipment
Powered Tools
Repetitive Motions
Sharp blades / drill bits
Slips, Trips and Falls
Trades/other workers
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
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
Barricades to limit access
Equipment guards in place
Insulate to reduce excessive noise
Isolate from Energy Source
Lighting
Scaffolding
Substitute hazardous chemicals for less toxic substance
Use hoists or equip to lift heavy loads
Ventilation
Other
3.2. Administrative Controls
*
N/A
Inspect Equipment
Limit Exposure times
Lockout / Tagout Procedure
Review SDS
Safe Job Procedure/Work Practice
Tidy the Work Area
Train workers
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
Add Images
Take a Picture
Drag and drop files here
Choose a file
Cancel
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
*
Site Superintendents Signature
This hazard assessment has been reviewed
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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