Page 1 of 2 Workplace Hazard Awareness Assessment Employee information Date oct. 25 Last Nome Dia Festtiame Thora pdtess 22 Shonfiels ay Se Home Prene'le 3 ~ 366-1803 Employer Information ‘Company Name_Mi on 5 sano erceoy Company Adcross Mg Bs > Mee Phone o2=627 Bist Hazard Assessment Step 1: Please check off all potential hazards at your work site, and add others as needed. Supervisor, repetitive motion Z vibration ilinglhandiing loads radiation slipping/tripping vf violence al moving machine parts. chemicals (specify below) | ov [working at heights. mists/vapours (specify below) pressurized systems fumes (specify below) vehicles viruses 3 fire ae moulds electric z bacteria noise sewage lighting v fatique 7 temperatures z stress: J ‘Step 2: Assess your tasks and procedures, and then write the hazards and plans in place to eliminate or minimize risk to you and others, Field Level Hazard Assessment Equipment Hazard Type Bian to Eliminate/Minimize Poncit etetivive x9 Hien Sahisn blents | gisve iite Neave" he ies thin Litate eatite rent: Che mri cas Peoftr Pfelo rian ¢ fam bie wirwsey went ak nee iP ling feaieh sag lac 3ueee and Mitlh ipns i Se Developed hy Carer Pathways 2007Page 2 of 2 Work Place Floor Plan Pace the following corresponding numbers in the appropriate areas. Add any important missing equipment and safety devices. Indicate the direction of north. Fire extinguishers 4 2. Power shutoff switches 3. Eyewash station 4. Fire-ext doors 5. All shop doors 6. First aid box 7. Brooms 8, 9 Signatures Employee: Employer: Coordinator: Date: Developed by Carcor Pathways 2007Monsignor McCay High Schoo! ~ Monsignor McCoy HS Facility Ma LockeDown 202" 8 Street NE, Medicine Hat, AS HAR SRG oY aia : Suitable Lock Down Area © Muiple Door Alert Preferred Lock-Down Area go to Roite i Doo: Unlocked Eney {id xeric Dor Lock Key DE Security Arn key Pad Hiden Spacts) orercies 140814