Pre-Job Safety Assessment (PSA)

STOP & THINK!

1.Look around Date Covered:
2.Assess Risks
identify hazard Subcontractor:
3.Control Task Location;
4.Resume Work
Risks Am I physically prepared & mentally focused?

Review the following at the work site and Only check the items which apply to the task.
List all the tasks and hazards you have checked on the back of the card.
In the third column, detail your methods of CONTROL.
Identified "HIGH RISK" tasks require "SITE SPECIFIC" Hazard Assessments continued with Step-by-step Procedures.
Shutdowns/Permits signed or posted Environmental Hazards Working at Heights Hazard
Notice Of Work Spill potential Barricades/Flagging & Signs
HVAC Weather Conditions Holes/Dangerous openings
Fire / Smoke MSDS reviewed Protect from falling items
Sprinkler Ventilation Required Powered platforms - AWP
Electrical Heat Stress Others working above/below
Water Other Workers in area Roof
Confined Space Inadequate lighting Ladders
Hot Work House Keeping Scaffolding/
Asbestos Secure Loose Materials Personal Limitation/Hazard
Other Activity Hazards Clear instructions provided
Infection Prevention and Control Trained to use tools or
Sensitive equipment in area
perform task
Dust Burn / Heat Sources Distractions in work area
Silica / Concrete Compressed gasses Working alone Communication
Asbestos Energized equipment Heavy lift /Awkward position
Mould Welding / grinding External noise levels
Condition of Electrical Cords and
Fiberglass / Insulation Physical Limitations
Tools
Equipment and/or Tools – Violence / Harassment
Drywall
inspected Assessment
Other Lookout procedure in place PPE Requirements
Ergonomics Hazards Airborne particles - chipping Mandatory: Hard hat
Working in tight area Other Minimum work boots
Part of body in ‘line-of-fire’ Access / Egress Hazards Safety glasses / Full face
Working above your head Partially obstructed Dust mask / Respirator
Pinch points identified Slip/Trip potential identified Hearing protection
Repetitive motion Excavations Other
Repetitive work in Scaffold - inspected and tagged When PPE in used as a
awkward position Control, it must be specifically identified.
Other Other
Pre-Job Safety Assessment: PSA Form – 2 of 2
Item Priority Tasks Hazards Controls
 Collapse of sides  Battering the sides of the
 Striking buried excavation can be sloped back at an
services angle that is sufficiently swalow that
the soil will not slip.
 Hazardous
 Shoring the sides of the
substances
excavation can be supported with
 People falling in metal or timber that is fixed in place
 Object falling in inside the excavation.
 Flooding  Trench box the sides of the
 Collapse of excavation can be temporarily
adjacent supported by metal box that can be
structures lifted into the excavation and move
along to give a protected area.
 The buried services should be
located using surface clues and
detection equipment. Various
devices can be used to detect
different types of services(such as
metal detector , hum detectors,
cable detector, ground radar.)
 Plans of the area of the
excavation should be obtained
 The excavation should be made
subject to a permit-to-enter.
Forced-air ventilation, air
monitoring and respiratory
protective equipment may be
necessary.
 Barriers should consist of
High
1. Excavation guard-rails (as for a scaffold
Risk work platform) to prevent
people falling in, and toeboards
to prevent objects being kicked
down into the excavation.
 Good lighting (both within the
excavation and at the edges)
and signage should be
provided.
 Long excavations should be
provided with crossing points
(bridges) that should be
similarly guarded in with
barriers and toe-boards.
 Access to the excavation
should be achieved by properly
positioned and secured
ladders.
 Ladders should extend five
rungs above the edge of the
excavation to give a secure
stepping-off point. They should
be routinely inspected.
 Vehicles should be prevented
from approaching the
excavation sides by use of
barriers and signage.
 Workers in the excavation
should wear hard hats to
protect them from falling
 objects. They should also wear
steel-toecap boots.
 Vehicle movement close to
unsupported excavations must
be minimized to prevent the
side of the excavation from
becoming loose as a result of
vibration.

1. Low Risk 2. Medium Risk 3. High Risk

All waste cleaned up and removed Yes No
All tools/equipment removed Yes No
Task area cleaned at shifts end Yes No
All members of crew MUST sign card before starting work. Do NOT sign until you understand and agree with the PSA.
Please print name below Signature Please print name below Signature
1. 10.
2. 11.
3. 12.
4. 13.
5. 14.
6. 15.
7. 16.
8. 17.
9. 18.
Prepared by:
OSH Supervisor/Officer Name and Signature:
Noted by:
Project PM/PE/SE/Foreman Name and Signature: