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Hazard Assessment
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Field Level Hazard Assessment
Project Address
Date / Time
Date
Time
Work to be Performed:
*
Framing Stage
*
Main Floor
Second Floor
Roof
Basement
EQUIPMENT & PPE
Heavy Machinery
Yes
No
Controls
Spotter
Exclusion Zone
Telehandler Operator Trained/Certified
Yes
No
PPE Mandatory
High Vis Vest
Steel Toes
Hard Hat
MAIN FLOOR
Open Excavation
Yes
No
Controls
Barricade
Fence
Snow/Ice
Yes
No
Controls
Salt/shovel
Delay
Open Stairwell
Yes
No
Controls
Barricade
Cover
Cords in Good Working Condition?
Yes
No
Controls
Repair
Replace
Ladders in Good Working Condition?
Yes
No
Controls
Repair
Replace
MAIN Condition? Controls
SECOND FLOOR
Perimeter Fall Hazard
Yes
No
Controls
Guardrail
Scaffold
Open Stairwell
Yes
No
Controls
Barricade
Cover
Snow/Ice
Yes
No
Controls
Clear
Delay
Fall Potential
Yes
No
Action
Fall Arrest
Cords in Good Working Condition?
Yes
No
Action
Repair
Replace
Ladders in Good Working Condition?
Yes
No
Action
Repair
Replace
ROOF
Perimeter Hazard
Yes
No
Controls
Harness
Toeboards
Snow/Ice
Yes
No
Controls
Clear
Delay
Ladders Secure
Yes
No
Action
Secure
Replace
Fall Arrest Used
Yes
No-Equipment
Action
Rope
Anchor
Basement
Overhead work (falling materials, strain from overhead fastening)
Yes
No
Controls
Hard hats and PPE required
Ladder and elevated work
Yes
No
Controls
Secure ladders and maintain 3-point contact
Mechanical bulkheads and confined work areas
Yes
No
Action
Use proper lifting techniques/team lifts
Ensure adequate lighting and ventilation
Keep work areas clean and clear
Maintain safe clearance below overhead work
Description of Hazard
Risk Level
Low
Medium
High
Recommended Actions
Name
Signature
Clear Signature
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