ࡱ> dfc%` (bjbjNN 4`,, G84#     333"""""""$#h0&"3/333"  "5553X  "53"555  0#&osX5"0#5&&55&I33533333""X333#3333 Pre-Job Hazard Assessment Form Job Description:Location:Expected Start Date:Expected Duration:U of T File No.:U of T Project Manager:Assessment By:Date Prepared:Page 1 of 1Important Notice: This hazard assessment has been prepared by U of T for its own project planning purposes, and to inform service providers of actual and potential hazards that may be encountered in performance of the work. U of T does not warrant the completeness or adequacy of this hazard assessment for the project, and the paramount responsibility for project hazard assessment rests with the service provider.COULD THE JOB RESULT IN:YESNONECESSARY PROTECTIVE MEASURESBlocking or obstructing exits or routes of egressImpeding evacuation of the buildingDisabling of any fire sensor, alarm, or suppression system (e.g. sprinkler heads, standpipes, etc.)Impeding access to any fire protection systems or equipmentPermanent relocation of any fire system elementsPropping doors open Use of fire or ignition sources (e.g. welding, propane torch, grinding, tar pots, kettles, open flame)Mechanical rooms or service areas will be insecure / open during the work (e.g. boiler rooms, elevator room, penthouse, sprinkler room, etc.)Excavation, trench digging or drillingDisturbance of insulation, plaster, vinyl tile or other materials that could contain asbestosIf yes, pre-project asbestos survey report is required. Work to be performed in accordance with asbestos regulatory requirements.Generation of significant amounts of dust from sanding or demolition of surfaces that may contain lead-based paint If yes, pre-project lead survey report is required. Work to be performed in accordance with Ministry of Labour Guideline for Lead on Construction Projects.Abatement of building materials or contents having significant mould contaminationIf yes, perform work in accordance with a recognized mould abatement guideline.Generation of airborne pollutants that may harm persons or result in objectionable odours Exposure of building features to possible water / rain / snow damage Impact on natural gas services, sewage lines, or electrical servicesLock-out of live electrical or mechanical systemsUse of fall arrest equipment / work at heightsTying off to roof anchors Requirement to file Notice of Project with Ministry of LabourService Provider Acknowledgement: We confirm receipt and review of this Pre-Job Hazard Assessment and acknowledge our responsibility for taking all necessary protective measures (which may exceed those cited herein) for performance of the job.Service Provider Name:Signatory for Service Provider:Date Signed:     U of T Doc. 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