eHazard Assessment
Site Specific OR Field Level Hazard Assessments
Your Name
*
Your Email
*
We will use your email to send a copy of the completed eHazard Assessment as a PDF
Date
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Work Site
Your Company
*
Who are you completing this eHazard Assessment for?
Just Myself
Our Work Crew
How Many in your Work Crew?
Including yourself
Enter Names of Work Crew
Foreman
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)
Have all workers in your crew received a job site orientation?
*
Yes
No
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
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 at height today (above 10 feet)?
*
Yes
No
Are you protected by guardrails?
*
Yes
No
Are you using 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 using powered mobile equipment?
*
Yes
No
2.1 What Physical Hazards have you identified
*
N/A
Awkward Loads
Dust
Extreme Temperatures
Falling Objects
Flying debris
Heavy Lifting
Noise
Poor Ergonomics
Poor Lighting
Powered Tools
Repetitive Motions
Sharp blades / drill bits
Slips, Trips and Falls
Vibration
Violence
Weather
Wildlife
Working around other trades on site
Working around PME
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
COVID 19
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
Insulate to reduce excessive noise
Set up lighting
Set up ventilation
Substitute hazardous chemicals for something less toxic
Use barricades to limit access
Use equipment guards
Use hoists or equip to lift heavy loads
Use scaffolding
Other
3.2. Administrative Controls
*
N/A
Inspect Equipment
Keep work area tidy
Limit Exposure times
Provide training for workers
Review SDS
Use Safe Job Procedure/Work Practice
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
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Take a Picture
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Choose a file
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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 #2
Work Crew Signature #3
Work Crew Signature #4
Work Crew Signature #5
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Next
Reassessment
Revised Time
AM
PM
AM/PM Option
Revised Time
Newly Identified Hazards
Additional Controls
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