Hazard Assessment Guideline - Delta Remediation

Delta Remediation

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- Step 1 of 4

Date / Time

Date

Time

Location

Job#

Supervisor/Meeting Leader

Current Weather & Temp

Today’s work activities

Mixing tanks
Water transfer (pumps)
Driving on site
Mobile equipment
Open excavations
Others (Where applicable)

Today’s work activities (Others)

Today’s concerns

Please check all items that apply then rate the item with a RISK LEVEL (Low, Medium, or High) Below table identify a control measure fo each hazard based on level of RISK that is not eliminated.

Working Conditions

Weather

Risk Level (Weather)

Working Conditions

Congestion

Risk Level (Congestion)

Working Conditions

Underground hazards

Risk Level (Underground hazards)

Working Conditions

Overhead hazards

Risk Level (Overhead hazards)

Working Conditions

Working at heights

Risk Level (Working at heights)

Working Conditions

Work over water

Risk Level (Work over water)

Working Conditions

Access/Egress hazards

Risk Level (Access/Egress hazards)

Working Conditions

Public Safety

Risk Level (Public Safety)

Working Conditions

Working Alone

Risk Level (Working Alone)

Working Conditions

H2S Site

Risk Level (H2S Site)

Working Conditions

Confined Space

Risk Level (Confined Space)

Working Conditions

Pinch Points

Risk Level (Pinch Points)

Working Conditions

Wildlife

Risk Level (Wildlife)

Save and Resume Later

Job Site Prep

Signs & Barriers

Risk Level (Signs & Barriers)

Job Site Prep

Monitors/Controls

Risk Level (Monitors/Controls)

Job Site Prep

Gas testing

Risk Level (Gas testing)

Job Site Prep

Equip. Prep

Risk Level (Equip. Prep)

Job Site Prep

Ground Disturbance

Risk Level (Ground Disturbance)

Job Site Prep

Ground Conditions

Risk Level (Ground Conditions)

Job Site Prep

Designated Spotters

Risk Level (Designated Spotters)

Job Site Prep

Procedures Reviewed

Risk Level (Procedures Reviewed)

Job Site Prep

Hot work

Risk Level (Hot work)

Job Site Prep

Fall Protection Plan

Risk Level (Fall Protection Plan)

Job Site Prep

Work area established

Risk Level (Work area established)

Tools & Equipment

Hand Tools Inspected

Risk Level (Hand Tools Inspected)

Tools & Equipment

Lighting

Risk Level (Lighting)

Tools & Equipment

Rigging Inspected

Risk Level (Rigging Inspected)

Tools & Equipment

Power Tools inspected

Risk Level (Power Tools inspected)

Tools & Equipment

Pre Trips/Mobile Equip

Risk Level (Pre Trips/Mobile Equip)

Tools & Equipment

Fire Ext. on Equip.

Risk Level (Fire Ext. on Equip.)

Tools & Equipment

Ladders

Risk Level (Ladders)

Tools & Equipment

Fueling equipment

Risk Level (Fueling equipment)

Tools & Equipment

Compressed gasses

Risk Level (Compressed gasses)

Tools & Equipment

Fall Protection inspected

Risk Level (Fall Protection inspected)

Tools & Equipment

PPE inspected

Risk Level (PPE inspected)

Emergency Response

Response Plan in Place

Risk Level (Response Plan in Place)

Emergency Response

Muster Area & Evac. route

Risk Level (Muster Area & Evac. route)

Emergency Response

Location of First Aid Kit

Risk Level (Location of First Aid Kit)

Emergency Response

Location of fire extinguishers

Risk Level (Location of fire extinguishers)

Emergency Response

Emergency #s / Radio

Risk Level (Emergency #s / Radio)

Emergency Response

Designated FA Attendant

Risk Level (Designated FA Attendant)

Emergency Response

SCBA unit

Risk Level (SCBA unit)

Emergency Response

Gas Monitor

Risk Level (Gas Monitor)

Emergency Response

Trained Personnel

Risk Level (Trained Personnel)

Emergency Response

MSDS Available (Where?)

Risk Level (MSDS Available [Where?])

Emergency Response

Safety Manual Available

Risk Level (Safety Manual Available)

Emergency Response

Spill Kit (where is it?)

Risk Level (Spill Kit [where is it?])

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ALL INCIDENTS AND NEAR MISSES ARE TO BE REPORTED TO YOUR SUPERVISOR

Potential Concerns to be Addressed

Is Emergency Preparedness & Response established and reviewed for the location? Control: Site specific Emergency Response Plan must be available.
Do you have a Hazard Assessment/JSA for each task to be performed? Control: Provide & review with and workers.
Are Power Tools, Equipment and Machinery required to perform "work at this location'? Control: Ensure they are used as designed by competent workers and operated within manufacturers specifications.
Are Equipment Certifications and/or Specifications required'? Control: We must confirm equipment is of sufficient size, strength & design for the proposed work.
Are you aware of any workers with allergies to foods and/or insects, or taking prescribed medication? Control: Notify supervisor / first aid attendant what or where control measures are: (i.e. epi-pen)
Have wind conditions been considered'? Control: Monitor direction of wind (dust, exhaust, trees, windsock, etc.
Are there any Chemical Hazards or Harmful Substances present'? Control: Reference Provincial Regulations for exposure limits. Identify chemical or substance: __________________Review and follow MSDS
Have the Provincial First Aid requirements been satisfied? Control:Rescue plan for Injured reviewed with crew. Refer to ERP.
Will there be any Confined Space entry? Control: Review and follow provincial regulatory requirements and ensure confined space hazard assessment, entry permits, and procedures are completed prior to entry.
Will Hoists or Lifting Devices be used'? Control: These devises must have an engineering certification available that is less than a year old. Operator must provide applicable training ticket upon request.
Are there any potential Fire or Explosion hazards? Control: Identify ignition sources, use continuous gas monitoring Explosion Prevention Plan, Fire suppression provided as per Wildfire Act.
General Safety Precautions identified? (Circle all that apply) Control: Daily housekeeping/ additional lighting / slips & trips/pinch points/traffic control
Will there be any lifting and handling of loads'? Control When practicable, utilize equipment. Tag lines and appropriate lifting techniques for manual lifts.
Is additional Personal Protective Equipment required for the proposed work? (Circle all that apply) Control: Respirator/SCBA or SABA/ Face shield / Goggles / Gloves Limb and body Protection Identify special: ___________________
Will workers he required to use respiratory protection? Control: Ensure workers are fit tested for face piece.
Have all workers received the clients general Safety Orientation? Control: All workers must receive orientation before commencing work.
Identify area Safety and Compliance Coordinator: Name: Carla Sidorchuk Phone: (780) 720-6423
Will Powered Mobile Equipment be used'? (i.e. Loader/ Skid-steer, etc.) Control: Operators must demonstrate competency / provide certification / possess a valid Provincial Driver’s License when on public roadways. Equipment over 700 kgs must have seat belts and rollover protection.
Will there be potential exposure to radiation? (use of X-ray Equipment, Naturally Occurring Radioactive Material (NORM) in surface equipment) Control: Check our JSA / Procedures. Establish safe distance with signage.
Will there be any Rigging required. involving the use of Slings, Cables, Ropes or Chains? Control: Confirm load rating and certification, inspect condition, safety latches on hooks etc. Rigging work must be conducted by trained workers.
Are any additional Safeguards required? (circle all that apply) Control: Equipment guards installed where required / barriers & fences as required.
Are appropriate Drinking Fluids. Toilet & Washing Facilities available for the # of workers? Control: Identify where. ______________________________________
Will an individual be Working Alone? Control: Ensure we have an appropriate working alone program in place.
Will there be any Excavating, or Ground Disturbance? Control: At minimum. Ground Disturbance Guidelines must be adhered to. Consideration for provincial “One call” (AB - I (800) 242-3447, BC - I (800) 474-6886, SK - I (866) 828-4888)
Have all WHMIS & TDG requirements been met'? Control: MSDS's applicable to the product used must be reviewed by the workers prior to use. Loads secure & appropriate placards displayed.
Will Lockout/Tagout and / or Isolation he required? Control: Review applicable LOTO Procedure. Equipment must be rendered inoperative & all energy sources must be isolated/locked/tagged.
Will any work be conducted near Overhead Power Lines? Control: Contact power service provider if within 7 meters of power lines to determine voltage/ safe distances / procedures required.
Will workers be exposed to Noise above the Provincial Occupational Exposure Levels? AB/BC -85 dba/SK - 80dba) Control: Appropriate hearing protection must be used.
Prior to performing Hot Work, Atmospheric Testing must be conducted and the results recorded below:** Control: Name (of tester) ______________ Time of reading _________LEL% ___H2S ppm CO%______ 02%____
Has a Designated Smoking Area been identified? Control: Identify where:____________________________
Has Jewelry been removed to protect the worker from injury.

Hazards

1. 2. 3. 4. 5.

Controls

1. 2. 3. 4. 5.

Specialized PPE Required? (i.e. Gas Monitors)

PPE Required: • Hard Hat • CSA Safety Glasses • CSA Steel Toe Boots • High Vis Vests • Gloves

Save and Resume Later

First Aid Attendant:

Emergency Contact Numbers

Radio Freq

Muster Area Location on site?

“ONE CALL” Contacted?

Ground Disturbance Permit?

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Note: Our Company agrees to comply with all applicable Government Regulations, Industry Recommended Practices and our client Guidelines / Policies. Our Company will identify all hazards that may be present at the worksite and ensure that all our workers have a complete understanding of the hazards, conditions and control measures in their Hazard Assessment.

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