HAZARD IDENTIFICATION FORM

• Audit Title

• Document No.

• Conducted on

  Date

• Prepared by

• Location
  Address

• Others consulted

• Are First Aid Kits present in all locations they are expected to be? (i.e. where hangers for kits are present)

  Yes

  No

• Have First Aid Kits been ordered for locations there are not present?

  Yes

  No

• Are First Aid Kits fully stocked? (Refer to supplier information for list of contents)

  Yes

  No

• Has a refill(s) been ordered?

  Yes

  No

• Is stock in the First Aid Kits within expiry?

  Yes

  No

• Has new stock been ordered to replace expired stock?

  Yes

  No

• Are eye wash stations present and stocked with eye wash solution in all locations they are expected to be? (i.e. where eye wash stations are present)

  Yes

  No

• Have locations deficient of eyewash bottles been restocked?

  Yes

  No

• Has an order been raised for adequate eyewash refills?

  Yes

  No

• Are all eyewash bottles within expiry?

  Yes

  No

• Have expired bottles been replaced with in-date stock?

  Yes

  No

• Has an order been raised for adequate eyewash refills?

  Yes

  No

• Has the emergency shower been tested in the last three months?

  Yes

  No

• Was the shower functioning as expected? (i.e. 75 L per minute)

  Yes

  No

• What issue(s) occurred?

• Are hazardous substances throughout the facility appropriately stored in hazardous substance cabinets? (i.e., are there loose bottles of substances left out, unlabelled beakers of substances, used cassettes present in the lab area, etc.)

  Yes

  No

• Are the passthroughs and lab areas clear of excess waste?

  Yes

  No

• Is Liquid Waste Stored On-site greater than 60 L?

  Yes

  No

• Has a collection been arranged for liquid waste?

  Yes

  No

• Is all clinical waste on site stored within waste containers/bins?

  Yes

  No

• Is a collection required for clinical waste?

  Yes

  No

Description of hazard

• Type of hazard

  Select Manual Task / Ergonomic Electricity Machinery and Equipment Hazardous Substance Temperatures / Weather effects Noise Radiation Biological Psychosocial Work design and management Health and Security Slip, fall, trip Other Fire

  • Manual Task / Ergonomic
  • Electricity
  • Machinery and Equipment
  • Hazardous Substance
  • Temperatures / Weather effects
  • Noise
  • Radiation
  • Biological
  • Psychosocial
  • Work design and management
  • Health and Security
  • Slip, fall, trip
  • Other
  • Fire

• Explain the hazard & the context in how the hazard poses a risk

• Add photo of hazard (if applicable)

  Media

Asses the risk

• What would a reasonably foreseeable outcome be if an incident occurred?

• Consequence - How severely can this affect someone

  1 Low

  2 Minor

  3 Moderate

  4 Major

  5 Catastrophic

• Likelihood - How likely is this event to reoccur

  1 Almost certain

  2 Likely

  3 Possible

  4 Unlikely

  5 Rare

• Risk Rating (refer to risk rating matrix, attached on next section)

  Low

  Medium

  High

  Extreme

Risk Rating Matrix

Control The Hazard

• Describe what immediate actions have been or will be carried out to correct the hazard

• Attach photo of completed corrective action (if applicable)

  Media

Long term recommendations

• Suggested long term action(s)

• Additional Comments (if required)

HSR, Supervisor, Safety Advisor or Manager comments

• What follow up action is required in your opinion

• Do you recommend that a formal risk assessment be conducted

Review of action/recommendation (to be completed at end of following quarter)

• Is further action required to minimize/eliminate the identified hazard?

  Yes

  No

• What further action is required?