• Location - Location of Facility

  • Department

  • Job/Task (Some jobs may have multiple tasks that warrant separate JHA)

  • Conducted on

  • Prepared by

Hazard Assessment

General Area

  • Which Emergency Response Drills Apply?

  • Does any specialty training apply?

  • Is specialty PPE provided and utilized

  • What type of specialty PPE is required?

  • Additional Requirements?

  • Pedestrian management assessed (Review access to/from area, walkways, Slip/Trip/Fall potential, impact or caught by/from potential)

  • What controls can be added?

  • Traffic Management assessed (Review traffic ways, blind spots and accessibility)

  • What controls can be added?

  • Appropriate signage in place (Caution, Hot/Cold, Exit/Not and Exit, Eye wash/Shower, PPE, High Voltage, 1st Aid, No Smoking, Fire Extinguisher, Etc...)

  • What controls can be added?

Hazard Assessments

  • Are fall hazards present? (Review working at heights, overhead fall hazards, ladders, anchor points, platform railing (top rail/mid rail/toe board), aerial lifts, step stools)

  • What PPE is required?

  • Are noise levels appropriate?

  • What hearing protection applies

  • Is there potential for flying projectiles/eye injury/dusts?

  • What PPE applies?

  • Are machines present and safe guarded against? (Review moving/automated equipment, fans, chains/sprockets, pinch/nip points, barriers and securement)

  • What controls can be added?

  • Is foot protection required?

  • What PPE applies?

  • Presence of sharp material

  • What PPE applies?

  • Presence of thermal hazards (Hot or Cold)

  • What PPE applies?

  • Presence of chemicals

  • What PPE applies?

  • Are there ergonomic hazards present? I.E.>repetition, design, height, reach, mobility, access, twisting or turning

  • Is administrative or procedural controls being used to minimize hazard?

Additional site hazards

  • Are there any additional hazards?

  • Other hazards in the works area include:


  • Certified By

  • Reviewed By

  • Date and Time

  • Photos Attached

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.