Field Level Hazard Assessment Field Level Hazard Assessment Job Location Date Time 121234567891011 : 0030 AMPM Form Completed By Traffic Control Considerations - traffic volume & speed, sight lines affected by hills &/or curves, lanes/width space to work. JOB Drainage No Yes Brushing No Yes Shoulder Mowing No Yes Shop No Yes Water Maintenance No Yes Patching No Yes Snow Removal No Yes Grading No Yes Sign Maintenance No Yes Sweeping No Yes HAZARDS Traffic No Yes Overhead Structures No Yes (eg. power lines) Gas Lines No Yes Road Surface Conditions No Yes (eg. icy, wet, muddy, uneven) Slopes No Yes Heavy Mobile Equipment No Yes Weather No Yes (eg. extreme heat/cold/wind) Danger Trees No Yes (eg. leaning, signs of decay/ breakage) Dogs/Animals No Yes Residents/Public No Yes CONTROLS/PROTECTION Traffic Control No Yes (Flaggers) Traffic Control Devices No Yes (Beacons, lights, signage) Locates with BC One Call No Yes (Colour-coded ground markings signaling utility lines) PPE No Yes Other No Yes Other Description HAZARDS Hard Hat No Yes Gloves No Yes Steel Toed Footwear No Yes High Visibility Apparel No Yes Hearing Protection No Yes Other No Yes Other Description Comments Add Pictures (if needed) Drop a file here or click to upload Choose File Maximum file size: 128MB CREW MEMBER(S) ON JOB Aaron Brown No Yes Allan Bachi No Yes Al Bylsma No Yes Brendon Cooper No Yes Brent Stowards No Yes Chris Cowden No Yes Curtis Holbrook No Yes Devin Chamberlain No Yes Jaida Brown No Yes Robert Postill No Yes Robin Crandlemire No Yes Tyler McNeill No Yes Warren Lightfoot No Yes Waylen Stowards No Yes Other No Yes Other Name Captcha Submit If you are human, leave this field blank.
