HAZARD ASSESSMENT

• File Name

• Job No. / Date

• Conducted on

  Date

• Prepared by

• Location
  Address

• This Report Must be Completed Every Week!

SITE INFORMATION

• Appropriate Signage?

  Yes

  No

  N/A

• Permits Up to Date & Posted?

  Yes

  No

  N/A

SAFETY

• First Aid Station

  Safe

  At Risk

  N/A

• Spill Kit

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• Eye Wash Station:

  Safe

  At Risk

  N/A

AREA HAZARDS

• Housekeeping

  Safe

  At Risk

  N/A

• Is Site Secure?

  Yes

  No

  N/A

• Work Area Safety Barriers

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Electrical Safety / Lockout Tagout

  Safe

  At Risk

  N/A

• Vehicle Traffic Safety

  Safe

  At Risk

  N/A

• Walkways

  Safe

  At Risk

  N/A

• Are Work Surfaces Clean / Clear of Debris?

  Yes

  No

  N/A

• Noise

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Weather Conditions

  Safe

  At Risk

  N/A

WORKER HAZARDS

• Exhibiting Fatigue / Stress?

  Safe

  At Risk

  N/A

• Fit for Work?

  Yes

  No

  N/A

• Working Alone / Spotter Needed?

  Safe

  At Risk

  N/A

• Medical / Physical limitations?

  Safe

  At Risk

  N/A

• Adequate Training?

  Yes

  No

  N/A

EQUIPMENT HAZARDS

• Tool Condition

  Safe

  At Risk

  N/A

• Equipment Condition

  Safe

  At Risk

  N/A

• PPE Condition

  Safe

  At Risk

  N/A

• Ladder / Scaffold Condition

  Safe

  At Risk

  N/A

MATERIAL HAZARDS

• Hazardous Material Containment

  Safe

  At Risk

  N/A

• Dust/ Gas/ Fumes/ Mist

  Safe

  At Risk

  N/A

• Flammables/ Explosives in Area

  Safe

  At Risk

  N/A

• Chemical Handling

  Safe

  At Risk

  N/A

CORRECTIVE ACTIONS

JOB NOTES

HAZARD REVIEW COMPLETED BY

• Name:

  Sign

SUPERVISOR SIGN OFF

• Name:

  Sign