CWS HAZARD

IDENTIFICATION FORM

Behaviors Reactions of People:

Adjusting PPE
Attaching Grounds
Rearranging Job
P
 erforming Lockouts
Changing Positions
Stopping Job

Calfrac Well Services

Behaviors Personal Protection

Equipment:
Legs and Feet
Arms and Hands
Eyes and Face
Head
Respiratory System
Ears
Behaviors - Tools &
Equipment:
Wrong for the Job
Used Incorrectly
In Unsafe Condition
Used Correctly
Behaviors - Procedures
and Housekeeping:
P
 rocedures Inadequate
P
 rocedure Not Followed
H
 ousekeeping Standards
Not Known/Understood
P
 rocedures Not Known/
Followed
H
 ousekeeping Standards
Inadequate
H
 ousekeeping Standards
Not Followed

Behaviors Positions of
People:
S triking Against Object
C
 ontacting Temperature
Extremes
I nhaling a Hazardous
Substance
Heavy Lifting
Repetitive Motions
Awkward Positions
Struck By Objects
C
 aught In, On, or
Between Objects
A
 bsorbing a Hazardous
Substance
Overexertion
S wallowing a Hazardous
Substance

Risk potential chart to help identify the potential:

4
Catastrophic
3
Major

Impact

Hazards:
People/Injury
Motor Vehicle
People/Illness
Slips and Trips
Wildlife
Temperature
Fire/Explosion
Environmental
Adverse Weather
Falls
Pinch Points
Noise
Equipment Failure
Property
Electrical
Exclusion Zone
Pressure
Occupational
Regulatory
Chemical
Fit for Duty
PPE

2
Serious
1
Minor
Remote

Unlikely

Likely

Frequent

Probability of Occurrence

4
EXTREME

Stop all activities unless risk controls

have been implemented and the risk is
reduced to a lower level.

3
HIGH

Extensive risk controls must be

immediately implemented.

2
MEDIUM

Represents a manageable
amount of risk.

1
LOW

Represents an acceptable
level of risk.

Calfrac Well Services

FRONT: Tear at perforation. Clearly fill out front and back.

Hazard Identification

At-Risk Behavior

Safe Behavior

Near Miss

District:
Date:

Time:

Company & Location: (If Lease - LSD or NTS, Town Road, etc.)

Location:
Shop
Yard

Office
Lease

Road
Other _______________

Coil Tubing
Engineering
Logistics

Mgt/Admin/Training
N2
Transport

Department:
Frac
Maintenance
Cement

Description of Hazard/Safe Behavior/

At Risk Behavior/Near Miss:

Immediate Corrective Action Description:

(See back for completion of form)

BACK: Tear at perforation. Clearly fill out front and back.

Was the Hazard Controlled? Yes No

If Applicable: Listed on the DVIR? Yes No N/A

Risk Potential for this Hazard ID, At-Risk Behavior, Near Miss:
Low

Medium

High

Extreme

Reported By:
_________________________ _____________________
Print
Sign
Crew Supervisor Review:
_________________________ _____________________
Print
Sign
Further Investigation and Corrective Action Needed?
Yes No
Description:

All High and Extreme reports are to be addressed immediately,

including Stop Work if required.