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FLHA Form
July 25, 2026
Working at Heights
Electrical Hazards
Confined Spaces
Hot Work (welding, soldering)
Heavy Lifting / Manual Handling
Slip / Trip / Fall Hazards
Overhead Hazards
Moving Equipment / Vehicles
Noise Exposure
Dust / Fumes / Chemical Exposure
Sharp Objects / Cut Hazards
Weather / Environmental Conditions
Working Near Public / Occupied Spaces
Lockout / Tagout Required
Other
Low – Routine task, controls in place
Medium – Some risk, extra precautions needed
High – Significant risk, supervisor approval required
Critical – Stop work, contact management
Hard Hat
Safety Glasses / Goggles
High-Visibility Vest
Steel-Toe Boots
Gloves
Hearing Protection
Fall Protection / Harness
Respiratory Protection
Face Shield
Arc Flash PPE
Other
None
Hot Work Permit
Confined Space Entry Permit
Excavation Permit
Lockout/Tagout Permit
Working at Heights Permit
Other
I have inspected the work area and identified the hazards listed above
I have the required training and certifications for this task
I understand the controls in place and will follow safe work procedures
I will stop work immediately if conditions change or new hazards are identified
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