Hazard Assessment and Control Form

Job Class Job title: Assessment Performed By: Date:

Temporary - Light Industrial Material Handler, Shipper/Receiver, February 6 2013
Warehouse Worker, General Labor, Name: Nicky Muir
Picker/Packer (all jobs that fall into our Light
industrial Service Lines) Title: Service Operations Manager Western Canada
Job Title: Manager, Regulatory Compliance,
Reviewed By: Corey Burt Job Title: Safety, Health, Environmental & Approved By: Kim Myles-Barclay Canada
WCB Specialist

Prepared Date: February 6 2013 Revised By: Felicia Gow, Dean Bergen, Shannon Baradoy, Leona Ferguson, Valerie Revision Date: February 22 Revision #2
McDonald 2013

Risk Rating Potential Hazard Preventative/Control Measure

Recommended
Hazard/Task L,M,H Engineering, Administrative, PPE (E.A.P.)
Controls/PPE
S P F
Material Handling Musculoskeletal injuries, Familiarization with the material handling safe work practice. E: Step stools should be
lifting, carrying Repetitive strain injuries Use proper lifting techniques made available to access
Slips, trips, falls Frequent breaks, weight limits, rotations and realistic materials on higher
Oversized/awkward quotas. shelves.
objects Get assistance when necessary, another worker, forklift, E: Use of dolly etc to
pallet jack etc transport heavy items
Follow safe work practices, ie guidelines for material when possible
handling E: Not placing heavy items
3 2 3 H
Use PPE ie, safety footwear, gloves, vests, hard hats etc on high shelves.
A: Development of Safe
Work Procedures for lifting
and training on the risk
factors and symptoms of
musculoskeletal injury –
perhaps provide during
orientation.
Severity: 1=low, 2=moderate, 3=high Probability: 1=not likely , 2=likely, 3= very likely Frequency: 1= rarely done, 2=not common task, 3=do this task frequently

© 2013 Kelly Services (Canada), Ltd. R8/13

 Hazard Assessment and Control Form
Risk Rating Potential Hazard Preventative/Control Measure
Recommended
Hazard/Task L,M,H Engineering, Administrative, PPE (E.A.P.)
Controls/PPE
S P F
Operating Forklifts, Forklift turnovers Obtain copy of forklift certification & document in employee E: Stack lighter items
Powered Industrial Trucks file. Check forklift references and have employee complete higher;
Falling product forklift evaluation. Ensure customer will provide machine
A: Properly maintain
specific orientation/training to employees. Have customer
equipment, including tires.
Foot injuries sign the Powered Motor Vehicle Release prior to the
assignment starting. A: Follow safe work
Crush injuries procedures for picking up,
Ensure housekeeping and safety programs are in place and putting down and stacking
“Run away” equipment clear areas of safe walk zones are marked and forklift loads.
training programs are in place & reviewed. Sound horn A: Training and
Inexperienced operator, when approaching pedestrians. certification for forklift
unsafe handling of operation.
vehicle, losing load Drive with due care and attention and obey all traffic A: Drive safely and slowly
regulations including plant speed limits. Look behind when never exceeding 5 km/h.
Environment - Weather reversing. If leaving forklift unattended, ensure it is in A: Lock out/ tag out
3 2 3 H conditions. Working in neutral, brakes are set and it is turned off with the key program to prevent
and outside may pose the removed. Ensure the forks are fully lowered. equipment from
risk of heat stress, cold or accidentally becoming
freezing temps and slips Drive slowly on wet or uneven surfaces. If noise level is energized.
and falls due to slippery over the legislative requirements, PPE will be required.
work conditions. Can be P: Wear toe caps when
a noisy environment. Operators are responsible for wearing the seatbelt or operating forklifts and
operator restraining device. Keep all body parts inside the transporting heavy items.
Pedestrians running lines of the forklift.

Other vehicles Ensure loads are safely arranged and stable according to
machines limitations. Caution must be taken when handling
off centre loads.

Do not have loads that exceed the trucks weighted

capability.
Severity: 1=low, 2=moderate, 3=high Probability: 1=not likely , 2=likely, 3= very likely Frequency: 1= rarely done, 2=not common task, 3=do this task frequently

© 2013 Kelly Services (Canada), Ltd. R8/13

 Hazard Assessment and Control Form
Risk Rating Potential Hazard Preventative/Control Measure
Recommended
Hazard/Task L,M,H Engineering, Administrative, PPE (E.A.P.)
Controls/PPE
S P F
Working on/near Docks - Forklifts run off docs Ascend and descend ramps/grades slowly when driving A: Drive forklifts slowly on
- Products fall on forklift. Drive slowly on wet or slippery surfaces. Load docks and dock plates.
employees should always be uphill when climbing or descending
A: Secure the dock plates
inclines. Place heavy, odd shaped objects with the weight
- Equipment strikes a and check to see if the
as low as possible
person plate can safely support
- Falling off dock the load.
Wear/use PPE
3 2 3 H - Slips, trips falls A: Keep clear of dock
- Environment Ensure housekeeping and safety programs are in place. No edges and never back up
dock jumping. forklifts to the dock’s edge.
A: Provide visual warning
signs near dock edges.
A: Prohibit “dock jumping”
by employees.
Dealing with Co-Workers, Workplace Violence Avoid working alone A: Violence Policy
Clients and General Public Ensure employees are trained on what to do in an A: Safe Work Procedure
2 2 3 M
emergency, ie call security & know how to call from location A: Training on Workplace
where they are working. Violence
Working Alone Becoming injured Ensure regular check-in procedures are in place for any E: Effective means of
Workplace Violence employees working alone. communication
Ensure there is an effective means of communication in A: Safe Work
place, ie 2 way radio, cell phone etc Procedure/Policy for
2 2 1 M First aid kit on site Working Alone
Familiarization with Safety Policies/Programs A: All workers should be
trained in the Safe Work
Procedure for working
alone, cover in orientation

Severity: 1=low, 2=moderate, 3=high Probability: 1=not likely , 2=likely, 3= very likely Frequency: 1= rarely done, 2=not common task, 3=do this task frequently

© 2013 Kelly Services (Canada), Ltd. R8/13

 Hazard Assessment and Control Form

Risk Rating Potential Hazard Preventative/Control Measure

Recommended
Hazard/Task L,M,H Engineering, Administrative, PPE (E.A.P.)
Controls/PPE
S P F
Working With and Near - Chemical Burns if WHMIS orientation & evaluation for all employees. Client E: Provide spill cleanup
Chemicals spills occur site specific WHMIS training, familiarization with MSDS and kits in areas where
know where they are kept at work site. chemicals are stored.
- - Exposure
- Inhalation A: Follow instructions on
Clean up any spills immediately (refer to MSDS for handling
the MSDS.
- Skin Absorption instructions)
A: Train employees on the
- Fire
If there is no label on the container STOP. Get your risks of each chemical
- Explosion being stored.
supervisor. Do not dispense/handle the produce until you
are certain you know what you are dealing with. A: Train employees to
clean up spills, protect
Familiarize yourself with the sites emergency themselves and properly
response/evacuation procedures. dispose of the used
materials.
3 2 2 M Wear PPE, ensuring that you have the correct PPE for the A: Store all chemicals
materials you are handling – refer to the MSDS sheets for safely and securely.
confirmation. A: Store chemicals away
from forklift traffic areas.
A: Flammable and
combustible materials
must be identified and
stored properly.
A: Fire equipment should
remain unobstructed.
A: Fire extinguishers and
alarms should be
conspicuously placed and
accessible.
Severity: 1=low, 2=moderate, 3=high Probability: 1=not likely , 2=likely, 3= very likely Frequency: 1= rarely done, 2=not common task, 3=do this task frequently

© 2013 Kelly Services (Canada), Ltd. R8/13

 Hazard Assessment and Control Form

Risk Rating Potential Hazard Preventative/Control Measure

Recommended
Hazard/Task L,M,H Engineering, Administrative, PPE (E.A.P.)
Controls/PPE
S P F
Working at Heights Injuries from falling Wear appropriate fall arrest equipment, safety harness, E: Lifts
lanyard etc A: Maintain 3 points of
Inspect safety harnesses daily before use and report and contact when working on
replace any damaged components immediately ladders.
Identify anchor points to be used and configuration of A: Do not work from the
lifelines or other systems top 2 rungs, steps or
Familiarization with customer policies for working at heights. treads of a step ladder.
3 1 1 M
Part 9 – Fall Protection of the OHS Code. Work within the A: Center of balance at the
guidelines of the code. centre of the ladder is
maintained at all times.
If working over 3m fall protection must be used.
P: Fall protection and fall
Training on using fall protection and maintenance of fall
arrest when working 3
protection equipment.
meters or higher.
Ensure guard rails are in place as outlined in the OHS code
– over 1.2 m but less than 3m
General Housekeeping Slips, Trips and Falls Ensure housekeeping and safety programs are in place and A: Floors and aisles are
Injuries from falling clear areas of safe walk zones are marked. clear of clutter, electrical
objects Remove any tripping hazards cords, hoses, spills and
Clean up any spills immediately other hazards that could
Conduct regular work site inspections cause employees to slip,
2 2 3 M trip or fall.
A: Loose/unboxed
materials which might fall
from a pile are properly
stacked and secured.

Severity: 1=low, 2=moderate, 3=high Probability: 1=not likely , 2=likely, 3= very likely Frequency: 1= rarely done, 2=not common task, 3=do this task frequently

© 2013 Kelly Services (Canada), Ltd. R8/13

 Hazard Assessment and Control Form

Risk Rating Potential Hazard Preventative/Control Measure

Recommended
Hazard/Task L,M,H Engineering, Administrative, PPE (E.A.P.)
Controls/PPE
S P F
Working with Electrocution Working with tools are risky as they may cause cuts, E: Equipment guards.
Equipment/Machinery repetitive strain type injuries, impact injuries and eye injuries
E: Equipment must be
Contact with moving parts if improperly used.
properly grounded.
(lacerations, abrasions,
fractures Ensure employees have received training and/or are E: Sufficient amount of
supervised on the appropriate equipment they are operating electrical outlet to prevent
circuit overloading.
Follow manufacturers operating instructions A: Check cords for frays.
2 2 3 M A: Electrical equipment
Stop using faulty equipment/machinery immediately. should be maintained.
A: Machines should be
Familiarization with lock out/tag out program and ensure disconnected before
you are following these instructions completely. cleaning or adjusting.
Generally machines and
equipment should be
locked or tagged out
during maintenance.
Computer work or Musculoskeletal injuries Ensure sufficient lighting E: Adjustable Chair &
handwritten inventory Repetitive strain injuries Take frequent breaks away from computer workstation
documents Stretch hands/wrists/forearms frequently
1 1 2 L P: Antistatic guards,
Ensure workstation is set up correctly
keyboard trays, wrist
Do a different task
guards.
Use available PPE, ie wrist guards, keyboard trays etc

Severity: 1=low, 2=moderate, 3=high Probability: 1=not likely , 2=likely, 3= very likely Frequency: 1= rarely done, 2=not common task, 3=do this task frequently

© 2013 Kelly Services (Canada), Ltd. R8/13

 Hazard Assessment and Control Form

Risk Rating Potential Hazard Preventative/Control Measure

Recommended
Hazard/Task L,M,H Engineering, Administrative, PPE (E.A.P.)
Controls/PPE
S P F
Travel Working alone Familiarization with emergency procedures for hotel A: Violence Policy
Violence accommodation. Keep hotel room door locked at all times.
A: Safe Work Procedure -
other work sites, Environmental – weather Be aware of your surroundings
working alone, driving etc
overnight stays, other conditions Familiarization/training with Kelly’s policies for working
Transportation alone, violence prevention. A: Training on Workplace
countries 1 1 2 L Violence
Ensure branch have itinerary and arrange regular check in
times.
Global Mobility engaged for foreign travel to ensure all
documentation is correct and that a 24 hr number is
provided for emergencies.

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Date:

Severity: 1=low, 2=moderate, 3=high Probability: 1=not likely , 2=likely, 3= very likely Frequency: 1= rarely done, 2=not common task, 3=do this task frequently

© 2013 Kelly Services (Canada), Ltd. R8/13