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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