Job Hazard Assessment

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job Description

• Photo of work area

  Media

Head

• Falling or Flying Objects

  Safe

  At Risk

  N/A

• Work Being Performed Overhead

  Safe

  At Risk

  N/A

• Drill rods

  Safe

  At Risk

  N/A

• Striking Against a Fixed Object

  Safe

  At Risk

  N/A

• Forklift Hazards

  Safe

  At Risk

  N/A

• Exposed Electrical Conductors

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Eye and Face

• Flying Particles

  Safe

  At Risk

  N/A

• Struck by drill equipment

  Safe

  At Risk

  N/A

• Liquid Chemicals

  Safe

  At Risk

  N/A

• Acids

  Safe

  At Risk

  N/A

• Caustic Liquids

  Safe

  At Risk

  N/A

• Chemical Vapors or Gases

  Safe

  At Risk

  N/A

• Light Radiation

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Foot

• Falling and Rolling Objects

  Safe

  At Risk

  N/A

• Objects Piercing the Sole

  Safe

  At Risk

  N/A

• Electrical Hazards

  Safe

  At Risk

  N/A

• Wet or Slippery Surfaces

  Safe

  At Risk

  N/A

• Chemical Exposure

  Safe

  At Risk

  N/A

• Environmental

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Hands

• Skin Absorption

  Safe

  At Risk

  N/A

• Cuts or Lacerations

  Safe

  At Risk

  N/A

• Abrasions

  Safe

  At Risk

  N/A

• Punctures

  Safe

  At Risk

  N/A

• Chemical Burns

  Safe

  At Risk

  N/A

• Thermal Burns

  Safe

  At Risk

  N/A

• Harmful Temperature Extremes

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Respiratory

• Harmful Dusts

  Safe

  At Risk

  N/A

• Fogs

  Safe

  At Risk

  N/A

• Fumes

  Safe

  At Risk

  N/A

• Mists

  Safe

  At Risk

  N/A

• Smokes

  Safe

  At Risk

  N/A

• Sprays

  Safe

  At Risk

  N/A

• Vapors

  Safe

  At Risk

  N/A

• Others

  Safe

  At Risk

  N/A

Torso

• Hot Metals

  Safe

  At Risk

  N/A

• Cuts

  Safe

  At Risk

  N/A

• Acids

  Safe

  At Risk

  N/A

• Radiotion

  Safe

  At Risk

  N/A

Miscellaneous

• Lifting

  Safe

  At Risk

  N/A

• Blood-borne Pathogens

  Safe

  At Risk

  N/A

Recommended Personal Protective Equipment

• Goggles

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Face Shield

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Rubber Boots

  Yes

  No

  N/A

• Steel Toed Boots

  Yes

  No

  N/A

• Leather Gloves

  Yes

  No

  N/A

• Chemical Gloves

  Yes

  No

  N/A

• Long Sleeve Rubber Gloves

  Yes

  No

  N/A

• Dust Mask

  Yes

  No

  N/A

• Half Mask Respirator

  Yes

  No

  N/A

• Full Face Respirator

  Yes

  No

  N/A

• SCBA

  Yes

  No

  N/A

• Harness

  Yes

  No

  N/A

• Full Body Suit (Tyvek)

  Yes

  No

  N/A

• Continuos Airflow Hood

  Yes

  No

  N/A

• Ear Plugs

  Yes

  No

  N/A

• Non-Routine Tasks

• Select date

  Date

• Department Representative

  Sign

• Health & Safety Manager

  Sign