Hazard Identification

Describe Hazard

Hazardous Condition

Unsafe Behavior

Possible Accident Types

Please specify

Risk probability

Risk severity

Recommended Corrective Action(s)

Engineering controls

Management controls

Personal Protective Equipment

Recommended System Improvement(s)

Specify recommended improvement(s)

Determination of Legal and other Requirements

Name of regulation/requirement

Reference #

Area of the organization it impacts

Interested parties

Document stipulating the requirement/compliance obligation

Responsible Person

Source of information (can be indicated in a hyperlink or description format)

Objective Planning

What is to be done?

Resources required (e.g., financial, human, equipment & infrastructure)

Responsible person

Target date of completion

Metrics for evaluation & indicators for monitoring

Priority Level

Approved by
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.