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MSDS reviewedErgonomic Hazards14.Awkward Body Position15.Over extension16.Prolonged twisting bendingmotion17.Working in a tight area18. Lift too heavy / Awkward to lift19.20.Working above your headScaffold (inspected & tagged)Ladders (tied off)Confined space entry permit& THINKField Level Hazard AssessmentPersonal Limitations / Hazards Procedure not available for taskConfusing instructions No training for task or tools tobe usedFirst time performing the taskTASKSPLANS TO ELIMINATE/CONTROLWork to be done: Company Name:Is the worker working alone?If Yes, please explain&Area cleaned up at end of job / shift?If Yes, explainPlease print and sign below (All members of the crew) prior to commencing work and initial when task is completed or at the end of the shift!Worker name and Signature (below)Slips. Trips and FallsChemical hazardsConfined Space Entry Rescue plan prepared Gas testing5051525354Emergency response planFirst aiders and supplies232425262728293031323334353637383940414243$(sign upon reviewing completed card)dIt is important that all hazards are identified and controlled. Confirm that all permits are valid.Hands not in line of sight SEVERITY: widespread occupational illness, loss of facilities%2. Serious - severe injury - illness property and or equipment damage or damage'3. Minor - non-serious injury, illness 4. Not Applicable - NAMSeverity + Probability = (Eg. Worker at heights without Fall Protection - 1A)21 Aerial lift man basket inspectedDoorways clear22Evacuation (alarm, routeOverhead HazardsBarricades and signs in placeHole coverings in placeHarness-lanyard inspected!100% tie off with harness, anchorpoints identifiedFalling objects Power lines!Hoisting or moving loads overheadFatigue$1. Imminent Danger - causing deathsWelding Safety eventuallyor soon PROBABILITY:+A. Probable - likely to occur immediately  (B. Reasonaly Probable - likely to occur&C. Remote - could occur at some point (D. Extremely Remote - unlikely to occur Muster Point:PPE Inspected: oIdentify and prioritize the tasks and hazards below, then identify the plans to eliminate/control the hazards. HAZARDSPriority<Has a pre-use inspection of tools-equipment been completed  Job CompletionAre any Hazards remaining?If yes please explain$Were there any incidents / injuries? Check cablesInspect bottles and hoses Fire blanketPlatform over wet groundUse of dust mask Restricted movements Barricades, screenss, flagging No flammables in area Hard HatsHearing protection5556Safety Eye wearSafety Foot wearFire Resistant coverallsStep 2. - Check off the hazards that apply to this job. (Step 3.) List the item # in the 2nd column. (Step 4.) Identify the plans to eliminate or control them in the 3rd column, include required PPE.CRemember: "Stop & Think" & "See It Again For The First Time". 3-10Name & SignatureRepresentative Review Signature Location:Approval from:Usage Date(s):Safety Orientatio Complete? 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