LINE OF FIREFIELD LEVEL HAZARD ASSESSMENT (FLHA)

For each question below, ask yourself “Are the existing safeguards satisfactory to reduce the risk to manageable level?”

Fall Protection Does your task require fall protection? ☐Yes ☐No

If Yes - Review and follow fall protection plan

Confined Space

Does your task require confined space? ☐Yes ☐No

If Yes - Are the correct control measures in place?

Specialized PPE

Do you require any special PPE gloves or respirators etc? ☐Yes ☐No

If Yes - Do you have the right PPE for the task?

Right Tools Do you have the proper tools for the task? ☐Yes ☐No

If Yes - Have you reviewed applicable Safe Work Practice (SWP)?

Lifting Are you doing any lifting of hoisting? ☐Yes ☐No

If Yes - Plan and follow proper rigging practices (SWP)

Overhead Work

Are you doing any overhead work? ☐Yes ☐No

If Yes - Are controls in place with workers below or above?

EnvironmentalDoes your work have potential to impact environment? ☐Yes ☐No

If Yes - Are you prepared for spill potential

Isolation Verification (Initial Required)

Mechanical Supervisor Tradesperson N/A

All mechanical energy sources have been isolated

Drain points assessed as adequate zero energy confirmedSingle isolation procedure/Risk Assessment performed, reviewed and documented

Verified by the Company and operations

First break required / single isolation

Isolation points completed and verified by the Company

Electrical Supervisor Tradesperson N/A

All electrical energy sources have been isolated

Bump test witnessed to confirm zero energy

Maintenance locks & tags installed

Bump test written on permit

All three questions need to be checked prior to work commencing Supervisor Tradesperson N/A

Confirmed correct equipment & location as per permit?

Identified correct equipment & location with crew?

Zero Energy Checks Completed?

LINE OF FIREFIELD LEVEL HAZARD ASSESSMENT (FLHA)

STOP Step back and observe

Do all crew members understand the scope of work? ☐Yes

THINK It Through

Are all crew members physically and mentally ready? ☐ Yes

ASSESS Hazards, Pathways, Impact

Make it safe, use the right tools and use the right procedure. ☐ Yes

REVIEW And document findings

We listed & implemented all the hazards/controls? ☐ Yes

TALK It through and complete the Task

We discussed the impacts with all persons involved in this task? ☐ Yes

Motion

☐ Yes

Line of Fire

☐ Yes

Temperature

☐ Yes

Housekeeping

☐ Yes

Chemical

☐ Yes

Gravity

☐ Yes

Electrical

☐ Yes

Radiation

☐ Yes

Pressure

☐ Yes

Kinetic Energy

☐ Yes

We are satisfied that ALL HAZARDS are controlled.If NOT, STOP & contact your foreman or supervisor. ☐ Yes ☐ No

We have reviewed the task and are ready to start

Name: Signature:

Name: Signature:

Name: Signature:

Name: Signature:

Simple isolations should be field verified each day/shift by next level of authority. Complex systems involving multiple isolations carrying over to multiple days/shifts

may be verified via handovers with previous Supervisor & Operations.