Hazard Identification and Health and Safety Plan

Field Visit
Emergency Plan Staff Name: ____________________________ Cell #: _________________

Contact: Stephen Lee Field Visit Date: ______________________ Time: ____________________

Head, Pavements and Foundations Section
Materials Engineering and Research Office Purpose of Trip: ________________________________________________
Ministry of Transportation
Tel: (647) 938-0708 Location: _____________________________________________________

Medical Service Required: ______________________________________________________________

Call 911 or ____________________ Travel Mode: ___________________ Licence Plate: __________________

HAZARD IDENTIFICATION
Traffic Water and Ice Noise
□ Park/Work on Shoulder □ Risk of Drowning (Depth >1ft) □ Exposed to sound level
□ Moving along or pulling off Shoulder □ Nearby Water or Ice >= 90 dBA for an 8 hr/day
□ Nearby Oncoming Traffic □ Fast Flow
□ Nearby Railway ROW □ Slow Flow Others
□ Night Work
Fall Confined Space □ Working Alone
□ Steep/Slippery Slopes □ Enter Confined Space (e.g. Culvert) □ Working at Remote Area
□ Rock or Earth Fill or Cut Adverse Weather and
□ Deep Excavation Solar UV □ Road Surface Condition
□ UV Exposure
Biological □ Construction Site
□ Insects/Animals Eye and Face
□ Poisonous Plants □ Flying Objects (e.g. drilling)

HEALTH AND SAFETY (H & S) PLAN

Personal Protective Equipment (PPE) Self-Protection Plan (SPP) Traffic Control Plan (TCP)
□ Hard Hat □ Avoid the steepest part of the slope □ Mobile Operation
□ Safety Shoes/Boots □ Access the underside of a structure □ Very Short Duration (<=30 min)
□ Tearaway Reflective Vest from access road □ Short Duration (30 min – 24 hr)
□ Reflector Bands for Arms and Legs □ Stay at least 2 m away from the □ Long Duration (>24 hr)
□ Flashlight edge of the water, ice, fill, cut, slope, □ Freeway
□ Safety Glasses railway □ Non-Freeway
□ UV Blocking Safety Glasses □ Do not approach animals □ Use Appropriate OTM Book 7
□ Hearing Protection (e.g. ear plugs) □ Field visit with ______ people Traffic Layout and Traffic
□ Respirators (e.g. mask) □ Bring Communication Device: Protection Plan (TPP) (See
□ Face Shield ________________ Attached)
□ Sun Screen
□ Long-Sleeve Tops and Long Pants □ Construction Site: Contact CCO/CA □ Follow TPP for Construction
□ Insect Repellent to arrange site visit Site or Field Visit with
□ Gloves/Coveralls □ Field Visit w/ Consultant/Contractor Consultant/Contractor
□ Fire Retardant Coveralls □ Participate Health and Safety (See Attached)
□ Bring Water Training from Consultant/Contractor
□ First Aid Kit

Prepared By: (Print) (Signature) (Date)

Reviewed By: (Print) (Signature) (Date)

MERO Field Visit H&S Plan v. June 2016

 Traffic Protection Plan (TPP)
Non-Freeway, Mobile Operation/Very Short Duration (<=30 min)

Shoulder Work
where workers, vehicles, and equipment are on the shoulder, but
do not encroach into the travelled lanes

General Traffic Control Measures/Safety Measures

 Activate 4 Way Flashers (4WF) and rotating beacon light on

roof to warn traffic (while pulling off and on to the travelled
portion of the road and during inspection).
 When and where it is safe to do so, pull vehicle off as far to
the right of the travelled portion of the road as possible.
 If stopping on the left, ensure the shoulder is at least 3 m in
width.
 Refrain from U turns in poor visibility areas and minimize
reversing of your vehicle.
 In areas where there is insufficient space to safely
accommodate the work vehicle on the shoulder of the road,
parking should be limited to driveways, side roads, etc.
 Always park vehicle +/- 30 m upstream of where you will be
working.
 Avoid turning your back to oncoming traffic (be aware of
vehicle hazard).
 Plan an escape route.
 Load/unload materials from the side of vehicle away from
oncoming traffic.
 Exit from Passenger Side if within 3m of pavement edge.
 Signal intention to enter roadway. Check traffic in all
direction and enter roadway when safe to do so.

Daily Inspection
 Ensure all traffic control devices, including Beacon Light,
4WF, and other traffic control devices required are working

Other Details

OTM Book 7 Work Zone Component Dimensions:

Table A (Very Short Duration)

 Normal Posted Regulatory Speed Limit: ____ km/h

 □ With Work Vehicle □ No Work Vehicle
 1b* Taper Length for Roadside Work: ______ m
 3* Maximum distance between Markers: ______ m Prepared By: ________________________________________
(Print)
 Minimum Number of Markers for Taper: ______
____________________________________________________
(Signature) (Date)

Reviewed By: ________________________________________

(Print)

____________________________________________________
(Signature) (Date)

MERO Field Visit H&S Plan v. June 2016

 Traffic Protection Plan (TPP)
Non-Freeway, Short Duration (30 min to 24 hr) Long Duration (>24 hr)

Shoulder Work
where workers, vehicles, and equipment are on the shoulder, but
do not encroach into the travelled lanes

General Traffic Control Measures/Safety Measures

 Activate 4 way flashers and rotating beacon light on roof to

warn traffic (while pulling off and on to the travelled portion of
the road and during inspection).
 When and where it is safe to do so, pull vehicle off as far to
the right of the travelled portion of the road as possible.
 If stopping on the left, ensure the shoulder is at least 3 m in
width.
 Refrain from U turns in poor visibility areas and minimize
reversing of your vehicle.
 In areas where there is insufficient space to safely
accommodate the work vehicle on the shoulder of the road,
parking should be limited to driveways, side roads, etc.
 Always park vehicle +/- 30 m upstream of where you will be
working.
 Avoid turning your back to oncoming traffic (be aware of
vehicle hazard).
 Plan an escape route.
 Load/unload materials from the side of vehicle away from
oncoming traffic.
 Exit from Passenger Side if within 3m of pavement edge.
 Signal intention to enter roadway. Check traffic in all
direction and enter roadway when safe to do so.

Daily Inspection
 Ensure all traffic control devices, including Beacon Light,
4WF, and other traffic control devices required are working

Other Details

OTM Book 7 Work Zone Component Dimensions:

Table A (Short Duration), Table B (Long Duration)

 Duration: □ Short □ Long

 Normal Posted Regulatory Speed Limit: ____ km/h
 1b* Taper Length for Roadside Work: ______ m
 3* Maximum distance between Markers: ______ m Prepared By: ________________________________________
(Print)
 3* Minimum Number of Markers for Taper: ______
____________________________________________________
 5* Distance between Construction Sign: ______ m
(Signature) (Date)
General Note
#4: Where a work vehicle is present with 4WF and Reviewed By: ________________________________________
rotating beacon and/or TC-12, the work vehicle can (Print)
replace cones/barrels only where indicated in the
o
typical layout. If 360 Beacon is used, the 4WFs are
____________________________________________________
not required to be operated continuously for longer (Signature) (Date)
duration work.

MERO Field Visit H&S Plan v. June 2016

 Traffic Protection Plan (TPP)
Freeway, Mobile Operation/Very Short Duration (<=30 min)

Shoulder Work
where workers, vehicles, and equipment are on the shoulder, but
do not encroach into the travelled lanes

General Traffic Control Measures/Safety Measures

 Activate 4 way flashers and rotating beacon light on roof to
warn traffic (while pulling off and on to the travelled portion of
the road and during inspection).
 When and where it is safe to do so, pull vehicle off as far to
the right of the travelled portion of the road as possible.
 If stopping on the left, ensure the shoulder is at least 3 m in
width.
 Refrain reversing of your vehicle.
 In areas where there is insufficient space to safely
accommodate the work vehicle on the shoulder of the road,
parking should be limited to driveways, side roads, etc.
 Always park vehicle +/- 30 m upstream of where you will be
working.
 Avoid turning your back to oncoming traffic (be aware of
vehicle hazard).
 Plan an escape route.
 Load/unload materials from the side of vehicle away from
oncoming traffic.
 Exit from Passenger Side if within 3m of pavement edge.
 Access to the median shall be from turn-around only when
the left shoulder is less than 3 m and stopping on the median
side is not safe.
 Signal intention to enter roadway. Check traffic in all
direction and enter roadway when safe to do so.

Daily Inspection
 Ensure all traffic control devices, including Beacon Light,
4WF, and other traffic control devices required are working

Other Details

OTM Book 7 Work Zone Component Dimensions:

Table C

 Normal Posted Regulatory Speed Limit: ____ km/h

 1b* Taper Length for Roadside Work: ______ m
 3* Maximum distance between Markers: _____ m
Prepared By: ________________________________________
(Print)
OTM Book 7 Application of Longitudinal Buffer Area
and Lateral Intrusion Deterrence Gap: ____________________________________________________
Table D (Signature) (Date)

 Work Operations: □ Stationary □ Mobile__

Reviewed By: ________________________________________
 Normal Posted Regulatory Speed Limit: ____ km/h (Print)
 Lateral Intrusion Deterrence Gap (LIDG*): _____ m
____________________________________________________
(Signature) (Date)

MERO Field Visit H&S Plan v. June 2016

 Traffic Protection Plan (TPP)
Freeway, Short Duration (30 min to 24 hr) Long Duration (>24 hr)

Shoulder Work
where workers, vehicles, and equipment are on the shoulder, but
do not encroach into the travelled lanes

General Traffic Control Measures/Safety Measures

 Activate 4 way flashers and rotating beacon light on roof to
warn traffic (while pulling off and on to the travelled portion of
the road and during inspection).
 When and where it is safe to do so, pull vehicle off as far to
the right of the travelled portion of the road as possible.
 If stopping on the left, ensure the shoulder is at least 3 m in
width.
 Refrain reversing of your vehicle.
 In areas where there is insufficient space to safely
accommodate the work vehicle on the shoulder of the road,
parking should be limited to driveways, side roads, etc.
 Always park vehicle +/- 30 m upstream of where you will be
working.
 Avoid turning your back to oncoming traffic (be aware of
vehicle hazard).
 Plan an escape route.
 Load/unload materials from the side of vehicle away from
oncoming traffic.
 Exit from Passenger Side if within 3m of pavement edge.
 Access to the median shall be from turn-around only when
the left shoulder is less than 3 m and stopping on the median
side is not safe.
 Signal intention to enter roadway. Check traffic in all
direction and enter roadway when safe to do so.

Daily Inspection
 Ensure all traffic control devices, including Beacon Light,
4WF, and other traffic control devices required are working

Other Details
OTM Book 7 Work Zone Component Dimensions:
Table C
 Normal Posted Regulatory Speed Limit: ____ km/h
 1b* Taper Length for Roadside Work: ______ m
 2* Longitudinal Buffer Area (LBA): _______ m
 3* Maximum distance between Markers: _____ m Prepared By: ________________________________________
 5* Distance between Construction Sign: ______ m (Print)

____________________________________________________
OTM Book 7 Application of Longitudinal Buffer Area (Signature) (Date)
and Lateral Intrusion Deterrence Gap:
Table D
Reviewed By: ________________________________________
 Work Operations: □ Stationary □ Mobile__ (Print)
 Normal Posted Regulatory Speed Limit: ____ km/h ____________________________________________________
 Lateral Intrusion Deterrence Gap (LIDG*): _____ m (Signature) (Date)

MERO Field Visit H&S Plan v. June 2016

 Traffic Protection Plan (TPP)
Construction Site or Field Visit with Consultant/Contractor

Name of Consultant/Contractor: ___________________________________________________________________

Consultant/Contractor Contact Number: ___________________________________________________________

General Traffic Control Measures/Safety Measures

 Activate 4 way flashers and rotating beacon light on roof to warn traffic (while pulling off and on to the travelled portion of
the road).
 When and where it is safe to do so, pull vehicle off as far to the right of the travelled portion of the road as possible.
 If stopping on the left, ensure the shoulder is at least 3 m in width.
 Refrain from U turns in poor visibility areas and minimize reversing of your vehicle.
 In areas where there is insufficient space to safely accommodate the work vehicle on the shoulder of the road, parking
should be limited to driveways, side roads, etc.
 Always park vehicle +/- 30 m upstream of where you will be working.
 Avoid turning your back to oncoming traffic (be aware of vehicle hazard).
 Plan an escape route.
 Load/unload materials from the side of vehicle away from oncoming traffic.
 Exit from Passenger Side if within 3m of pavement edge.
 Access to the median shall be from turn-around only when the left shoulder is less than 3 m and stopping on the median
side is not safe.
 Signal intention to enter highway. Check traffic in all direction and enter roadway when safe to do so.

Specific Traffic Control Measures/Safety Measures

 Follow Consultant/Contractor instruction to enter the Construction Site
 Consult with Consultant/Contractor for Hazards Specific to Construction Site
 Participate Health and Safety Training
 Follow Consultant/Contractor Traffic Control Plan and Health and Safety Plans

Others Scheduling, Traffic, Hazard or Emergency Descriptions

Prepared By: (Print) (Signature) (Date)

Reviewed By: (Print) (Signature) (Date)

MERO Field Visit H&S Plan v. June 2016