First Five Minutes

Please complete this form and click “Submit” below to acknowledge you have discussed potential hazards with the group before heading out or starting work. To be completed by one on-site leader/supervisor (whether this person be staff or volunteer). FRIENDLY REMINDER TO START YOUR MOBILE TIMECLOCK! This meets the legal requirement of a Site-Specific Hazard Assessment as laid out in the Alberta Occupational Health & Safety Code and the Friends of Fish Creek Safety Manual. All Safe Work Practice documents can be found in the Friends of Fish Creek Volunteer Handbook at the bottom of of this page.

Company
This field is for validation purposes and should be left unchanged.
First & Last Name of Individual Completing Form*
Date*
MM slash DD slash YYYY
Start time*

: Hours

Minutes

AM/PM
Programs*
If Other please describe
Event Name & Location
Activity or Outing Type (ie. yoga, fence repair, weed pull)*
Health and Safety Screening
- No illness reported
- Illness reported – volunteer went home
Please ensure that all volunteers are free of illness and are able to volunteer. For everyone’s safety, if a volunteer feels ill before or during the activity, they must not participate in the volunteer activity, and return home or seek medical attention if needed.
This field is hidden when viewing the form
IN-PERSON ACTIVITIES ONLY: Conduct COVID-19 Screening (questions below) with all Volunteers and/or Participants. If anyone answers yes to any of the questions, they are not permitted to take part in the activity and must return home.
- Screening conducted – NOONE answered yes to any of the questions.
- Screening conducted – AT LEAST ONE PERSON answered yes to at least one of the questions.
- N/A – Online Event or post July 1
This field is hidden when viewing the form
COVID SCREENING QUESTIONS – For reference only, no need to check.
- Have you or someone in your household been diagnosed or currently being investigated as a suspected case of COVID-19 in the last 10 days?
- Are you showing any signs and symptoms of illness (fever, cough, shortness of breath/difficulty breathing, sore throat, runny nose, chills, body aches, conjunctivitis, loss of taste/smell, etc)
- Please let the group leader/supervisor know if you begin to experience any symptoms, and discuss a plan for you to return home immediately, without stopping on the way.
- Please be sure to inform the Friends if you test positive for COVID-19, so that we can make every effort to support contract tracing.
This field is hidden when viewing the form
Please describe situation, persons who answered yes to screening.
Meeting Place / Muster Point*
If there is no signed Muster Point, the muster point will be the same as the meeting place. Please describe meeting place (ie. Hull’s Wood parking lot).
Please describe meeting place.*
For example, Hull’s Wood parking lot.
This field is hidden when viewing the form
Meeting Place / Muster Point
When the meeting place is a parking lot or by vehicles, the muster point is the same as the meeting place.
Does one of the on-site leaders/supervisors have a working cell phone? In case of emergency, call 9-1-1.*
- Yes
- No
At least one of the on-site leaders/supervisors is required to have a cellphone with them. If there is no cellphone, please explain why.
Volunteer Agreements: New Volunteers were invited to complete Volunteer Agreement (WCB discussed).*
- Yes
- N/A
ENVIRONMENTAL HAZARDS: Check & discuss those that apply, or choose N/A*
- Select All
- AIR QUALITY – due to smoke or contamination (monitor conditions and fellow volunteers, cancel if AQI is high)
- FALL hazards – cliffs, slopes (be aware, proper footing & footwear)
- FIRE or WILDFIRE – high risk or proximity (no smoking/idling)
- INFECTION (stay home if you have cold/flu symptoms, wash hands well & often, do not touch face, 2m distancing, no sharing)
- INSECTS (cover skin, check for ticks, inform leaders of allergies)
- SECURITY – vehicles and belongings (lock vehicles & keep valuables on person)
- SNOW & ICE (ice cleats, be aware)
- SPILLS – fuel or liquids (focus on task, take time, ensure safe work site, clean up spills)
- TRAIL CONDITIONS (plan safe route, proper footing & footwear)
- TRAIL USERS – construction, cyclists, dogs (stay alert)
- TREES or POWER LINES (be aware, stay away from hazardous/beaver-gnawed trees)
- TRIP hazards – roots, deadfall, uneven ground, extension cords (be aware, proper footwear)
- WATER (stay away from water)
- WEATHER – cold, heat, severe (clothing, sunscreen, take breaks, shelter)
- WILDLIFE – large mammals (stay together as group, leave area)
- WINDS (stay alert and out in open, monitor, cancel if needed)
- N/A – Not Applicable
ERGONOMIC HAZARDS: Check & discuss those that apply, or choose N/A*
- Select All
- BODY POSITION (ensure proper positioning for task)
- HANDS NOT IN SIGHT – network wiring or handywork (wear gloves, be aware of potential hazards)
- LIFTING (find help, bend with knees, lift w/legs)
- PROLONGED MOTION – twisting, repetitive or bending (take breaks, alternate tasks)
- TIGHT SPACES – network wiring (best possible body position, work mindfully)
- WORKING OVERHEAD – tree pruning, banner hanging, network wiring (take breaks, body awareness)
- N/A – Not Applicable
TOOL HAZARDS: Check & discuss those that apply, or choose N/A*
- Select All
- BROKEN TOOLS (inspect before use, use undamaged tools, report & tag broken tools)
- FAULTY PPE (PPE Inspected)
- IMPROPER TOOL USE (receive instruction/review Standard Operating Procedures for specific tools (pulaskis, post pounders, planting bars, rakes), use right tool for the job)
- OFFICE EQUIPMENT (use shredder, paper cutter, etc. with care)
- OTHER tool hazards (properly stow & transport tools)
- N/A – Not Applicable
OTHER HAZARDS: Check & discuss those that apply, or choose N/A*
- Select All
- EAR BUDS (do not wear when walking or working)
- SMOKING (do at a safe distance away from others, safely dispose of butts)
- GLASS CONTAINERS (use stainless steel or plastic containers)
- N/A
Did you identify the location of tools, PPE, masks & hand sanitizer?*
- Yes
- No
- N/A
Is everyone wearing appropriate clothing and sturdy, closed-toe footwear?*
- Yes
- No
- N/A – Online Event
Identified any First Aiders on-site*
- Yes
- No
- N/A
Signage posted*
- Yes
- No
- N/A
Any known personal limitations (allergies, medical conditions) of relevance in the group?
- Yes
- No
- N/A
Please describe known personal limitation|(s):
Supervision*
The group leader has been identified to the group.
Concerns/Safety*
Guidance was shared regarding who approach should a concern or safety issue arise.
Additional Comments

Friends of Fish Creek Volunteer Handbook

Click here to complete Last Five Minutes Form