Hazard Assessment Worksheet

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Name (s)

Hazard Source

Type/ Class of Hazard

• Existing hazards

• Generated Hazard

• Potential Hazard

• Physical - Unsafe conditions ( eg mud/ice/blocked exit)

• Atmospheric/Environmental- Unsafe conditions (eg temperature)

• Inadequate training- Unsafe Acts

• Invisible - Indirect causes of accidents(eg noise)

Recommended Control Measure