Job Task
  • Enter a detailed description of the fall hazard here. Include location, equipment involved, department, and any other pertinent information required for identification.

  • Severity: How many feet (meters) above the next highest working surface is the employee required to conduct work?

  • The hazard is < 4 feet (1.22 m) above the next lowest working surface.

  • The hazard is 4ft (1.22m) - 10ft (3.05m) above the next lowest working surface.

  • The hazard is 10ft (3.05m) - 15ft (4.57m) above the next lowest working surface.

  • The hazard is 15ft (4.57m) - 25ft (7.62m) above the next lowest working surface.

  • The hazard is > 25ft (7.62m) above the next lowest working surface.

  • Frequency: What is the frequency of unprotected work from this height? Unprotected work includes the use of a harness or other fall protection equipment. It does not include work where an engineering control prevents exposure. Pick the answer that best matches the actual frequency.

  • Employees are exposed to this hazard less than once per year.

  • Employees are exposed to this hazard two to five times per year.

  • Employees are exposed to this hazard six to twelve times per year.

  • Employees are exposed to this hazard once a week to once a month.

  • Employees are exposed to this hazard twice a week or more.

  • Hazard Multiplier: How many additional hazards exist that could increase the liklihood of injury in the event of a fall? (ex. chemical exposure, swing hazards, dangerous equipment below, remote work)

  • There are zero additional hazards.

  • There is one additional hazard.

  • There are two additional hazards.

  • There are three additional hazards.

  • There are four or more additional hazards.

  • Describe all additional hazards in detail. Ensure there are as many descriptions as there are number of identified additional hazards.

  • Is there a feasible engineering/elimination solution for this hazard?

  • Describe high level details of the proposed solution(s).

  • Describe other controls that may need to be implemented (ex. PPE, administrative,etc.)

  • Are appropriate tie-off points available?

  • The final score is based on the answers above. The higher the number, the higher the hazard associated with this job task. Final score = (Severity x Frequency x Hazard Multiplier)

  • Signature of Auditor

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