Field Level Risk Assessment (FLRA)

FIELD LEVEL RISK ASSESSMENT (FLRA)
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Date*

YearMonthDay
Date
Time
Name*
Please enter your full name
Location*
Email
example@example.com
Job #
Supervisor
Name
Signature*

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Daily Task(s)*
Slips/Trips/FallsExposure to NoiseWorking at HeightsWorking in Tight SpacesHot SurfacesConfined Space EntryLimited AccessPinch PointsOperating Power EquipmentAwkward Body PositionsMetal Grinding / SparksFirst Time Performing TaskCorroded MetalsChemical ExposureElectrical HazardsCritical LiftWeather - HotWeather - ColdAirborne ContaminantsFlammable ProductsWorking AloneSurrounding TrafficSurrounding WorkersVibrationOverhead HazzardsHot WorkPoor VisibilityOther
Safety GlassesHand ProtectionCareful DrivingHearing ProtectionFall protectionFull Face ShieldIdentify Tie-OffsAir CirculationReview MSDS/SDSHousekeepingFire ExtinguisherBe Aware / AlertRespiratorsLock Out / Tag OutUse Care / CautionStay ClearPPEFR CoverallsGas MonitorBarricades / SignsReview Rescue PlanOther
Additional Hazards and Controls
General Work PermitConfined Space EntryHot WorkCold WorkOther
Permit Number
Muster points ID'd?
Safety Topic Discussed with Crew: Please note any items that may be out of the ordinary that may effect the safety of the crew (high wind, new equipment, new crew member....)
Additional Crew Members
Worker 1
Name
Worker 2
Name
Worker 3
Name
Worker 4
Name
Signature Worker 1

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Signature Worker 2

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Signature Worker 3

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Signature Worker 4

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Should be Empty:

FIELD LEVEL RISK ASSESSMENT (FLRA)