• Employee Health Risk Assessment

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Site Manager

  • Photograph of Building

  • Additional photograph

Specific workplace hazards

  • Are any recognizable hazards present?

  • Choose one or more as needed

Routine Employee Health

  • How are immunization booster services handled?

  • How are flu shots administered?

  • How is TB Testing done???

Fire Prevention

  • Fire doors close and latch?

  • Smoke doors close?

  • Doors wedged?

  • Exit signs illuminated?

  • Fire alarms accessible?

  • Fire extinguishers accessible?

  • Flammables stored appropriately?

  • Medical gas stored appropriately?

  • Smoke detectors unobstructed?

  • Sprinklers unobstructed?

  • Appropriate use of decorations?

Security Management

  • Medications secured?

  • Syringes and needles secured?

  • Medical records secured?

  • Staff wearing IDs?

  • Belongings secured?

Log Sheet Documentation

  • OSHA Log?

  • Crash carts - daily?

  • Refrigerators - daily?

  • Fire Extinguishers - monthly?

Safety Management

  • Electrical cords and plugs in a safe condition?

  • Extension cords are not in use?

  • GFI outlet within 6' of water source?

  • Electrical panels accessible (3')?

  • Corridors unobstructed?

  • Emergency reference guides available?

  • Flashlights available?

  • Lifting equipment available?

  • Stairwells clear?

  • Step stools available?

Utilities Management

  • Building in good repair?

  • Ceiling tiles stained?

Clinical Equipment

  • Current PM sticker?

  • Alarms disabled?

Hazardous Materials

  • Appropriate use of utility rooms?

  • Sharps containers overfilled?

  • PPE available?

  • Products properly labeled and stored?

Infection Control

  • Respiratory Hygiene Protocol in place?

  • Hand-washing observed?

  • Linen covered?

Waste Management

  • Appropriate items in general trash?

  • Appropriate items in red bags?

  • Appropriate items in RCRA cans?

  • Appropriate items in sharps container?

Recommended Follow-up?

  • Follow-up for manager?

  • Follow-up for Facilities?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.