FIELD LEVEL RISK ASSESSMENT EMERGENCY PREPAREDNESS

 H2S Monitor  CO Monitor

SAFETY CONCERNS
Answer the following questions:
FLRA will be completed for each task. Keep at task  Safety Shower # ______ ____ Wind direction
location. Each crewmember involved with the task will  Name 2 EAA Locations: ________________________ Do you require a pre job meeting?
agree to mitigation and sign this FLRA. At the end of the
task, submit this FLRA to Supervision. If a deviation from EMPLOYEE TRAINING REQUIRED Should your Foreman be involved in the planning of this
safe work practice and or procedure occurs, work must  Forklift  Mobile Equipment job?
be stopped and your foreman contacted.  Vehicle Operator  Fall Arrest
Foreman: ________________Date: ___________  Spark Watch  Confined Space What precautions are being used to mitigate weather
 Bottle Watch  Competent Persons conditions?
Job/Task Location: ______________________________  Other (Specify) ____________________________ _
Will cords, cables and hoses be kept out of walkways,
Job/Task Description: ___________________________ PERSONAL PROTECTIVE EQUIPMENT
ladders and away from hot surfaces? Yes/no
Project: _________________ Foreman req to attend □ Fall Protection Hand (Gloves)
 Full-Body Harness  Leather  Latex Is the material being stored out of walkway? Yes/no
Name Signature  Other_____________  Welding  Other
Workers on site less than 6 months check box  Retractable  Chemical Resistant
Have all scaffolds and ladders been inspected?
 Tied Off Above Shoulder  Kevlar
□________________________________________ Eye/Face Are scaffold tags current? Tag #
□_________________________________  Safety Glasses Appropriate For Lighting
 Goggles  Spoggles If Windy
□_________________________________  Welding Hood  Face Shield
Is a fire watch, bottle watch or confined space attendant
□_________________________________ required? Name: _______________________
Respirator
□_________________________________  Fit Tested  Respirator Type ____________ How do you summon help?
□_________________________________ Foot
 Metatarsal Guards  Rubber Boots
□_________________________________ What fall protection system is required to perform the job
Head task?
PROCEDURES / PERMITS REQUIRED  Hard Hat  Hard Hat / Weld Combination
 Hot Work  Cold Work Hearing Anchor Point, what are you tied off to?
 Low Risk  Lockout / Tag out  Single Protection  Double Protection
 Excavation  Rescue Plan Clothing What type of barricades are you using?
 Confined Space & Permit  Tag Line  Chemical Resistant  Fire Retardant
 Multiple Worker Task  Pylons  Tyvek Disposal (FR)  Wrist Protectors What type of access do you have to work?
 Line Break/Hot Tapping  Flag Person
 Other PPE Required: _____________________
 Hazardous Material Compliance  Crane Lift
 Vehicle walk-around  Sewers Sealed 3. List Actions To Eliminate Hazards
 Tools, Cords/Cables, Rigging Inspected 2. List Hazards Associated with Task and Tools
 Permit reviewed with Crew; Permit #______________ ______________________________________
______________________________________ ______________________________________
□ JSA reviewed with crew if needed
______________________________________ ______________________________________
1. List Job Steps and tools to be used ______________________________________
__________________________________ ______________________________________
______________________________________ ______________________________________
__________________________________ ______________________________________
__________________________________ ______________________________________
_________________________________________ ______________________________________
__________________________________
_________________________________________ ______________________________________
__________________________________ _________________________________________
__________________________________ ______________________________________
_________________________________________ ______________________________________
__________________________________
__________________________________ Foreman Approval ___________Time_________

JMD/SB Dec 4 06
Employees shall not perform any non-routine task, which
requires use of, or potential exposure to a hazardous
substance which is not normally handled by the
employee. A review of this task must be conducted by
supervision / management prior to executing the work.
Area Specific Hazards:
icy/slippery surfaces, Heat, Wind, yellow tag
scaffold, process leaks, tight access, other
crews, poor housekeeping, rain , noise, traffic,
lighting, difficult tie off, no anchor points, no
permanent walkways, uneven ground, Room to
operate tools, Space to install material, Room to
store material, Room to run cables, cords,
hoses, Process equipment or products,
flamables
1.____________________________________
2.____________________________________
3.____________________________________
4.____________________________________
5.____________________________________
6.____________________________________
7.____________________________________
8.____________________________________
9.____________________________________
10.___________________________________
How will hazards be eliminated or
managed? (Include additional PPE/Action
req.)
1.____________________________________
2.____________________________________
3.____________________________________
4.____________________________________
5.____________________________________
6.____________________________________
7.____________________________________
8.____________________________________
9.____________________________________
10.___________________________________
SUBMIT PROJECT SAFETY DEPT. WEEKLY
JMD/SB Dec 4 06
JOB AND DAILY CLOSE OUT
Strathcona Refinery
Foreman: __________________________________
Date: ______/______/______
1. Was anyone injured or did an unplanned
incident occur today
If yes, explain. Yes _____ No _____
______________________________________
2. Was it reported to the safety department?
Yes _____ No _____ N/A _____
3. What problems did you have with today’s work
assignment?
______________________________________
______________________________________
4. What can we do to improve performance?
______________________________________
______________________________________
5. What did your foreman add to this plan?
______________________________________
______________________________________
Field
______________________________________
6. Work site clean-up done □
7. Materials secured □
8. Tools returned □
Reviewed by:
General Foreman: _____________________________
Level
Risk
Superintendent: _____________________________
Safety Department: _____________________________
Assessment
Employee Sign off
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
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