APPENDIX A Activity Hazard Analysis

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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: Project/ Location: Plan Prepared by: Next Two Weeks Scope of Work: Contractor: Meeting date: 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. __________________ _________________________________ __________________________ ________________________________________ ________________________________ ______ _______________________ ________________________________________ ________________________________ ______ ________________________________________ __________ _________________________________

Steps of Task Hazard/Reaction to Change Safe Plan Resources Team Members’ Signatures The signature of the supervisor confirms the completion of the hazard assessment and Safe Plan of Action by the crew. Supervisors Signature: Date Instructions: 1. Write name of job or task in space provided. 2. Conduct walk-through survey of work area. 3.

  Analysis, Activity, Survey, Hazards, Activity hazard analysis