Evolution Daily Workplace Inspection & Hazard Identification Form

Evolution Daily Workplace Inspection & Hazard Identification Form

• Dave K

  Martin C

  Mike B

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

Hazard Assessment

• 1 = Very hazardous, previous accident or high potential of accident
  2 = Hazardous with moderate risk
  3 = Low risk
  4 = O.K.
  5 = Not applicable (N/A)

• Housekeeping

  1

  2

  3

  4

  5

• Ventilation

  1

  2

  3

  4

  5

• Flammables (fire/explosion)

  1

  2

  3

  4

  5

• High Risk Positioning

  1

  2

  3

  4

  5

• Overhead Hazards

  1

  2

  3

  4

  5

• Restricted Access/Egress

  1

  2

  3

  4

  5

• Working at Heights

  1

  2

  3

  4

  5

• Major Lifts (Hoisting)

  1

  2

  3

  4

  5

• Power Tools

  1

  2

  3

  4

  5

• Fatigue

  1

  2

  3

  4

  5

• Lighting

  1

  2

  3

  4

  5

• Extreme Temperatures

  1

  2

  3

  4

  5

• Hazardous Materials

  1

  2

  3

  4

  5

• Electrical Hazards

  1

  2

  3

  4

  5

• Confined Space Entry

  1

  2

  3

  4

  5

• Ladders

  1

  2

  3

  4

  5

• Scaffolds

  1

  2

  3

  4

  5

• Mobile Equipment

  1

  2

  3

  4

  5

• Communications / Work Alone

  1

  2

  3

  4

  5

• Note Additional Hazards

• Add media

  Media

• Add drawing

  Drawing

• I / We have conducted a safety meeting and discussed the hazards as per the above checklist, have determined the need, and made provisions for any corrective actions.

  Yes

  No

• Tap the "Add Signee" button as many times as you need.

Signee

• Type Name and Press Sign

  Sign

• Why?

• Tap the "Add Signee" button as many times as you need.

Signee

• Type Name and Press Sign

  Sign