Winter Weather Work Risk Assessment Form
Assess winter weather conditions, site hazards, controls, and work status before work begins.
Work Details
Site or Location Name
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
First Name
Last Name
Assessor Job Title
*
Work Type / Activity
*
Please Select
Maintenance
Construction
Delivery/Transport
Inspection
Outdoor Operations
Emergency Response
Other
Weather and Site Conditions
Current temperature range
*
Below -20°C
-20°C to -10°C
-10°C to 0°C
0°C to 5°C
Above 5°C
Other
Wind condition severity
*
Calm
Light
Moderate
Strong
Very strong
Other
Precipitation / ice / snow conditions
*
None
Snow
Freezing rain
Sleet
Rain
Ice pellets
Other
Visibility
*
Clear
Good
Reduced
Poor
Very poor
Other
Ground / route condition
*
Cleared surface
Snow cover
Packed snow
Slush
Black ice
Wet surface
Icy patches
Other
Exposure, Controls, and Decision
Main Hazards Observed
*
Slippery surfaces
Black ice
Snow accumulation
Icy equipment or tools
Poor visibility
Strong winds
Cold stress
Frostbite risk
Falling snow/ice from structures
Vehicle or machinery traction issues
Other
Required Controls or Precautions in Place
*
Salt or de-icing applied
Surface cleared of snow/ice
Non-slip footwear used
High-visibility clothing worn
Warm-up breaks scheduled
Wind exposure reduced
Equipment inspected for winter conditions
Work area cordoned off
Spotter or supervisor assigned
Emergency communication available
Other
Overall Risk Rating
*
1
2
3
4
5
Work Status Recommendation
*
Proceed
Proceed with modifications
Delay work
Stop work
Other
Notes / Recommendations
Submit
Should be Empty: