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Revised: 02/03/2023 1 ACTIVITY HAZARD ANALYSIS Date Prepared:02 / 03 / 2023 AHA No.:20230127-002 Project Name:Various Activity/Work Task:Concrete Form Work Department/Division/Section:All Location(s):Various Developed By:Terry Dussault Start Date:02 / 01 / 2023 Duration: Modified Level D PPE Required: Hardhat, Form Fitting Safety Glasses, Steel toe Boots, High Visibility Vest, Long Sleeves, Knee Pads, Cut Resistant Gloves, Rubber Gloves, Rubber Boots Supervisor:TBD Reviewed By:Health and Safety Department Overall Risk Assessment Code (RAC): M RISK ASSESSMENT CODE MATRIX E=EXTREMELY HIGH RISK H=HIGH RISK M=MODERATE RISK L=LOW RISK PROBABILITY FREQUENT LIKELY OCCASIONAL SELDOM UNLIKELY S E V E R I T Y CATASTROPHIC E E H H M CRITICAL E H H M L MARGINAL H M M L L NEGLIGIBLE M L L L L Job Steps Hazards Actions to Eliminate or Minimize Hazards RAC 1. Form Curb and Gutters - Sharp objects - Puncture from splinter - Crushed Hands - Sprains and Strains to body from lifting - Heat Stress - Lacerations 1. Be aware that metal stakes could have a sharp burr or edge, wear Level II Cut resistant Gloves when handling stakes and/or wood. 2. Visually inspect wood before moving it, if there is obvious splintering remove it immediately. 3. Do not place your hands in the Line-of-Fire when hammering stakes into ground. 4. Do not lift more than 50 lbs. without using the "buddy system" or mechanical means (i.e., Forklift, Reach-lift). Do not overextend your arms when moving heavy or awkward loads as it could cause strain on various muscle groups like shoulders or lower back. 5. Always monitor the weather conditions and follow guidelines set forth in the Heat Illness Prevention Program. 6. When cutting wood for forms ensure that wood is secure and cut on a stable surface, do not hold wood one-handed while cutting with a skill saw using the other hand. L NC-25-1137 Tiwana & Sons 1210 East Hammer Lane, Stockton, CA 95210