Field Level Hazard Assessment (FLHA)

Used for individual job task groups. Divide job tasks (vertical, suspended slab, finishing, general labour) into separate groups — do not use one FLHA for multiple job task groups.

Send completed forms to (safety officer email): Remembered on this device. A draft of this form auto-saves as you type.

Job Details

Site Name

Job Group

Contractor

Date

Time

Worker Rep

Form / Reference No.

Location, Job Tasks, Hazards & Controls

#	Location	Job Task	Associated Hazards	Controls

Worker Concern

Worker concern raised? Yes No

Location (if yes)

Workers will have their concern noted here; for example, "worker (name) raised a concern with access/egress (see notes)".

Notes

Worker Sign-Off

Close Out

Supervisor Name

Supervisor Signature

FLHA Close Out Time