<title>2026-05-28_MSSS

FIELD LEVEL HAZARD ASSESSMENT

OHS PROGRAM – CONSTRUCTION SAFETY

FORM #FLHA-01 | REV. 01

SECTION 1 – PROJECT INFORMATION

Date

Time

Weather Conditions

Project Name / Site

Working Area

Supervisor Name

SECTION 2 – TASK ANALYSIS

1. Task Steps	2. Hazard	4. Control Measure
Drilling and epoxying GL E/18-19	Silica dust exposure.	Follow proper protocol and related safe work procedures. Set up control zones appropriately.
Cleaning up rebar around 6800 wide x 1600 dp footing	Slips, trips and falls. Cuts and wounds from sharp rebar edges.	Proper PPE. General awareness of surroundings.
Working around mobile equipment (Excavators etc.)	Serious injury hazard when working in close proximity of excavators and other operational mobile equipment. Clear signage and appropriate control zones.	Clear communication and eye contact with operator before entering the radius of operational mobile equipment. High awareness of surroundings/ other trades in close proximity.

SECTION 3 – PRE-USE INSPECTION

Pre-use Inspection done for:

PPE (Hard Hat / Safety Boots / Hi-vis Vest)

Yes No

Specialized PPE (Fall Pro/Respirator/Face shield etc)

Yes No/NA

Tools & Equipment for the job at hand

Yes No

Other:

Yes No

Exclusion Zones/Public Safety

Work areas/zones/levels barricaded i.e. danger tape

Yes No/NA

Surrounding trades notified (Warning Sign posted)

Yes No/NA

Objects (materials, tools & equipment) are tethered

Yes No/NA

Traffic Control Layout/Plan implemented

Yes No/NA

Applicable SWP/SJP Reviewed for the job?

Yes, Identify below NO

SECTION 4 – PERMITS & CRITICAL TASKS

Confined Space:

Yes No/NA

Hazardous Products Exposure Control Plans & SDS:

Yes No/NA

Leading Edge:

Yes No/NA

Silica Dust Exposure Control Plan:

Yes No/NA

Hot Work:

Yes No/NA

Fall Protection Plan (If above 25ft):

Yes No/NA

Ventilation Plan:

Yes No/NA

Other:

Yes No/NA

Other:

Yes No/NA

SECTION 5 – AFTER JOB/SHIFT END

Any new hazards introduced as a result?

Yes No

Are such hazards controlled/communicated?

Yes No

Any incident/Accident First Aid, Porperty Damage today

SECTION 7 – WORKER PARTICIPATION & SIGN-OFF

By signing below, I acknowledge that I have participated in this hazard assessment and understand the controls required for the tasks identified.

#	Worker Name	Trade / Role	Signature
1
2
3
4			Sign on printout
5
6
7			—
8			—
9			—
10			—

SECTION 8 – SUPERVISOR / FOREMAN REVIEW

Supervisor Name

Review Date

Signature