APPENDIX A Activity Hazard Analysis

APPENDIX A

Activity Hazard Analysis

Note:

Activity Hazard Analysis will be prepared and

inserted prior to the start of work

APPENDIX B

Forms

Risk Mitigation Two-Week Look-Ahead Form

Safety plan for

week ending:

Contractor:

Project/

Location:

Meeting date:

Plan

Prepared by:

Next Two Weeks Scope of Work:

Dated:

Identified Risks/Exposures/Hazards:

Control Measures:

Additional Activity Hazards Analysis Required:

Subcontractors Mobilizing/Demobilizing:

Audit/Inspections Scheduled:

Competent Person Changes:

Planned Orientation/Training :

Recommendations/Comments/Concerns:

Note: This information should be incorporated into the meeting minutes.

SAFETY MEETING SIGN-IN SHEET

Safety Meeting Presenter: _______________________________ Date:

__________________

Current Weather Conditions:

Temperature (oF) = _____ Wind Direction = _______ Wind Speed = _________

Clear - Sunny ¨C Cloudy ¨C Rain - Snow

Forecast =

_________________________________

Current Site Conditions (circle as appropriate):

Dry - Wet - Muddy - Frozen - Snow Covered - Other (describe)

__________________________

1. Incidents or Injuries to report from Previous Day Activities (circle one): No ¨C If Yes,

explain below:

________________________________________________________________________

______

2. Safe and/or At-Risk Observations from Previous Day Activities:

_______________________

________________________________________________________________________

______

3. Activities Taking Place Today:

__________________________________________________

________________________________________________________________________

______

________________________________________________________________________

______

3. Anticipated Hazards:

__________________________________________________________

________________________________________________________________________

______

________________________________________________________________________

______

4. Engineering Controls-Work Practices-PPE to Protect Against Hazards:

__________________

________________________________________________________________________

______

________________________________________________________________________

______

5. Additional Safety Topic or Comments:

____________________________________________

________________________________________________________________________

______

________________________________________________________________________

______

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