Title Page

  • Client / Site

  • Date and Time of Inspection

  • Inspected by

  • Location

Assessment

Hazard Identification

  • Enter description of procedure, task, or worksite being assessed

Biological (e.g. hygiene, disease, infection)

  • Are there biological hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose the type of hazard

  • Kindly specify

  • Description of hazard

  • Take a photo (Optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Chemicals

  • Are there chemical hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose the type of hazard

  • Description of hazard

  • Photo of hazard (optional)

  • Name of chemical(s) / Details

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Critical Incident

  • Are there critical hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose type of hazard resulting in:

  • Kindly specify

  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Energy Systems

  • Are there energy system hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose the type of hazard / incident or issues involving:

  • Kindly specify

  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Environment

  • Are there environment hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose type of hazard

  • Kindly specify

  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Facilities / Built Environment

  • Are there facilities / built environment hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose type of hazard

  • Kindly specify

  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Machinery, Plant and Equipment

  • Are there machinery, plant and equipment hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose type of hazard

  • Kindly specify

  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Manual Tasks / Ergonomics

  • Are there manual tasks / ergonomics hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose type of hazard

  • Kindly specify

  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

People

  • Are there people hazards observed?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Choose type of hazard

  • Kindly specify

  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

Others

  • Are there any other hazards not listed above?

  • Click Add Hazard after you have observed and identified a hazard

  • Hazard
  • Description of hazard

  • Photo of hazard (optional)

Risk rating

  • Consequence

  • Likelihood

  • Risk rating

Controls

  • Select control measures

  • Kindly specify

References

  • Risk Matrix Reference

    Screen Shot 2018-05-21 at 11.14.28 am.png
  • Hierarchy of Controls Reference

    OSH toolkit noise - hierachy of controls.jpg

Monitor and Review Controls

  • Are the planned control measures sufficient and effective in minimizing the level of risk?

  • Are further control measures required in future?

  • Have there been any changes to the planned control measures?

Completion

  • Recommendations

  • Full Name and Signature of the Inspector

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.