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Field Level Hazard Assessment Template

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Inspection
Field Level Hazard Assessment
Briefly describe your tasks for the shift.
Before Commencing Work
List the hazards in your work area by tapping ADD HAZARD.
Type of Hazard
Specify the hazard.
Take photos of the hazard in your work area.
How did you control the hazard?
During Task Execution
Were changes made to your current tasks?
List all changes made to your current tasks by tapping ADD TASK UPDATE.
Briefly describe the task update.
Type of hazard associated with the task update.
Specify the hazard.
Take photos of the hazard in your work area.
How did you control the hazard?
Were you given new tasks during your shift?
List all new tasks to be done during your shift by tapping ADD NEW TASK.
Briefly describe the new task.
Type of hazard associated with the new task.
Specify the hazard.
Take photos of the hazard in your work area.
How did you control the hazard?
Did new workers come on site?
Identify potential hazards by tapping ADD POTENTIAL HAZARD.
Type of Hazard
Specify the potential hazard.
Take photos of the hazard in your work area.
How did you control the potential hazard?
Did job site conditions change?
List all changes in job site condition by tapping ADD JOB SITE UPDATE.
Briefly describe the change in job site condition.
Type of hazard associated with the change in job site condition.
Specify the hazard.
Take photos of the hazard in your work area.
How did you control the hazard?
Completion
I cleaned up my work area at the end of my shift and my tools and equipment have been inspected.
Full Name and Signature of Construction Worker
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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