JOB SITE HAZARD ASSESSMENT

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

SITE INFORMATION

• Scope of Work:

SAFETY

• Location of First Aid:

• First Aider:

• Fire Extinguisher:

  Yes

  No

  N/A

• Eye Wash Station:

  Yes

  No

  N/A

• Muster Location:

EMERGENCY CONTACTS

• Supervisor:

• Site Contact:

• Fire Department:

• Police:

• Ambulance:

AREA HAZARDS

• Environmental Hazards

  Safe

  At Risk

  N/A

• Weather Conditions

  Safe

  At Risk

  N/A

• Noise

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Wet/ Slippery Surfaces

  Safe

  At Risk

  N/A

• Others Working in Area

  Safe

  At Risk

  N/A

• Moving Vehicles

  Safe

  At Risk

  N/A

• Fall from Heights

  Safe

  At Risk

  N/A

PEOPLE HAZARDS

• Medical/ Physical limits

  Safe

  At Risk

  N/A

• Fatigue/ Stress

  Safe

  At Risk

  N/A

• Fit for Work

  Safe

  At Risk

  N/A

• Working Alone

  Safe

  At Risk

  N/A

• Adequate Time

  Safe

  At Risk

  N/A

• Training Required

  Safe

  At Risk

  N/A

MATERIAL HAZARDS

• 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

EQUIPMENT HAZARDS

• Tool Condition

  Safe

  At Risk

  N/A

• Equipment Condition

  Safe

  At Risk

  N/A

• PPE Condition

  Safe

  At Risk

  N/A

CORRECTIVE ACTIONS

• Enter any corrective actions necessary

JOB NOTES

HAZARD REVIEW COMPLETED BY

• Name:

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• Name:

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• Name:

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• Name:

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SUPERVISOR SIGN OFF

• Name:

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