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Non-Routine Hazardous Task Assessment

This document is a form for establishing safe procedures for performing non-routine hazardous tasks. It requires identifying the task, its location and timing. It also requires identifying impacted areas, required team members and their competencies, the work execution plan including tools/equipment, risks/hazards and controls. The plan must be accepted by the supervisor and workers, authorized, and have a job task observation to ensure controls are followed.

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204 views4 pages

Non-Routine Hazardous Task Assessment

This document is a form for establishing safe procedures for performing non-routine hazardous tasks. It requires identifying the task, its location and timing. It also requires identifying impacted areas, required team members and their competencies, the work execution plan including tools/equipment, risks/hazards and controls. The plan must be accepted by the supervisor and workers, authorized, and have a job task observation to ensure controls are followed.

Uploaded by

drakonii
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Task Description and Details
  • Execution Plan
  • Approval and Task Observation

Non-Routine Hazardous Task Form

Non-Routine Hazardous Task

A non-routine hazardous task is defined as a task performed less than once per quarter, which, if controls are not
established, may result in Category 4 or 5 on the risk assessment matrix.

The employer and the joint health and safety committee or the health and safety representative shall jointly establish
safe procedures for performing a non-routine hazardous task. OHSA Reg. 854 – 62.1 (4)

1. Purpose
What non-routine hazardous task is being performed (describe the expected results)?

Where is this task being performed?

When is the planned work date of this task?

2. Impact

Indicate areas or pieces of equipment outside of the immediate area that might be affected. (eg: work below or
above, interlocked equipment, etc.)

What controls are in place to manage the impacted areas or equipment (as per last question)?

3. Team Members and Competencies

Indicate the personnel required to perform this task and any competencies they must possess.

Supervisor Special Competencies

Members

Printed copies are not controlled.


Version Document Number Page
Superintendent (or delegate) intials ____ 2 KOP-SAF-FRM-00014 1 of 4
Worker representative intials ____
Non-Routine Hazardous Task Form

Printed copies are not controlled.


Version Document Number Page
Superintendent (or delegate) intials ____ 2 KOP-SAF-FRM-00014 2 of 4
Worker representative intials ____
Non-Routine Hazardous Task Form

Detailed Work Execution Plan Personal Protective Risks or Hazards Controls


Tools / Equipment
(Execution of work – Start to finish estimated task duration) Equipment (PPE)
1)

2)

3)

4)

5)

6)

If at any stage of this non-routine hazardous task you cannot complete the task as described, you are to stop and contact your supervisor for further direction.

4. Procedure

(Print extra copies of page 3, if the plan cannot fit within the six steps available on this page and adjust the steps numbers to reflect the change)

Printed copies are not controlled.


Version Document Number Page
Superintendent (or delegate) intials ____ 2 KOP-SAF-FRM-00014 3 of 4
Worker representative intials ____
Non-Routine Hazardous Task Form

5. Acceptance (Name and Signature):

Name (Print) Signature

Supervisor

Safety Delegate (optional)

Members

6. Authorization (Name and Signature):

Name (Print) Signature

Superintendent or Manager or Delegate

Worker Certified Member or H&S Representative

7. Job Task Observation:


Supervisor identified in Section 5 above must visit the worksite and perform a Job Task Observation. The
purpose of the assessment is to ensure that all controls listed in the “Detailed Work Plan” are in place and that
all workers are following the documented instructions. Record of the Job Task Observation is to be sent to the
Safety Department for data entry and filing.

Printed copies are not controlled.


Version Document Number Page
Superintendent (or delegate) intials ____ 2 KOP-SAF-FRM-00014 4 of 4
Worker representative intials ____

Superintendent (or delegate) intials ____ Worker representative intials ____ Non-Routine Hazardous Task Form Non
Superintendent (or delegate) intials ____ Worker representative intials ____ Non-Routine Hazardous Task Form Pri
Superintendent (or delegate) intials ____ Worker representative intials ____ Non-Routine Hazardous Task Form Det
Superintendent (or delegate) intials ____ Worker representative intials ____ Non-Routine Hazardous Task Form 5.

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