Construction Risk Assessment Form

21 Feb 2023 / 372-2345 / Jeremiah Ronson Complete

Score 81.82% Flagged items 1 Actions 1

Site conducted Unanswered

Job #

372-2345

Conducted on 21.02.2023 09:00 PST

Prepared by Jeremiah Ronson

3516 Lakeland Park Drive,

Proposed work description

Construction of 2-story building as new retailer complex.

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Flagged items & Actions 1 flagged, 1 action

Flagged items 1 flagged, 1 action

Audit / Working at Height

Working at Height At Risk

Photo 1

To Do | Assignee SafetyCulture Staff | Priority Low | Due 28.02.2023 09:08 PST | Created by S
afetyCulture Staff

Loose scaffolding on the west side of the building. Foreman was immediately informed. This
problem should be fixed before the end of the day. Prohibit workers from working on or
underneath loose scaffolding.

Other actions 0 actions

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Audit 1 flagged, 1 action, 81.82%

Instructions
-------------------------
1. Answer "Safe", "At Risk", "N/A" for each of the hazards below
2. If "At Risk", follow the questions to identify the likelihood of occurrence, severity and risk rating
3. Include any notes and photos by clicking on the paperclip icon and then "Add Image"
4. Answer the relevant control questions
5. Complete the form by providing the relevant signatures

Confined Space 100%

Confined Space Safe

Working at Height 1 flagged, 1 action, 33.33%

Working at Height At Risk

Photo 1

To Do | Assignee SafetyCulture Staff | Priority Low | Due 28.02.2023 09:08 PST | Created by S
afetyCulture Staff

Loose scaffolding on the west side of the building. Foreman was immediately informed. This
problem should be fixed before the end of the day. Prohibit workers from working on or
underneath loose scaffolding.

Likelihood of occurrence Likely to occur

Injury and/or fatality by being struck by objects or through possible falls are imminent unless
scaffolding issues are fixed ASAP. Action already created.

Severity Fatality/ Disability

In relation to the loose scaffolding detected in the previous entry.

Risk rating High

Working at height permit received No

Height safety harness worn Yes

Enter description of control measures

All workers and personnel were cleared from the immediate vicinity of the loose scaffolding. A
"restricted area" was established with barriers and tapes to ensure that no one would be in danger
of falling objects from the loose scaffolding detected.

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Restricted Access 100%

Restricted Access Safe

Electricity 100%

Electricity Safe

Compressed Air

Compressed Air N/A

Uneven/slippery Surfaces 100%

Uneven/slippery Surfaces Safe

Hazardous Gases 100%

Hazardous Gases Safe

Asbestos 100%

Asbestos Safe

Vehicular movement 100%

Vehicular movement Safe

Dust & Airborne particle's 100%

Dust & Airborne particle's Safe

Working over/near water 100%

Working over/near water Safe

Overhead hazards 100%

Overhead hazards Safe

Manual handling 100%

Manual handling Safe

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Fire / Explosion 100%

Fire / Explosion Safe

Noise 100%

Noise Safe

UV 100%

UV Safe

Buried/Covered services 100%

Buried/Covered services Safe

Lone worker 100%

Lone worker Safe

Spills / Pollution 100%

Spills / Pollution Safe

Completion 0%

Observations and recommendations

Standards, materials, and practices concerning scaffolding, working at heights, and falling objects
must be reviewed. Loose scaffolding was detected in the west side of the building which had the
potential to cause major injuries and fatalities.

Work completed No

Equipment is safe & fit to operate No

Customer representative

Jordan Rank
21.02.2023 09:10 PST

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Appendix

Photo 1

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