Personnel and Scope


VP of Operations

Regional Manager

Area Manager

Account Manager


Regional Safety Director

Regional HR Director

Scope of Work

Attach a copy of the Contract ' s Scope of Work to this Assessment

Specific Tasks within Scope of Work


Existing Facilities Available

Comments or additional information

Equipment Needed

Comments of additional information

Risks Based On Tasks

Physical Hazards

Does the Scope include facility cleaning?

Select hazards introduced by facility cleaning tasks

Does the Scope include landscaping services?

Select hazards introduced by landscaping services

Does the Scope include Transportation/Rental Car Services?

Transportation/Rental Car Services Hazards

Does the Scope include warehouse services?

Warehouse hazards

Additional hazards not listed.

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.