Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General

  • Date / Time

  • Project Name

  • Foreman

  • Crew Size

  • Superintendent

Identified Hazards

  • Hazard Priority
    1.Very hazardous
    2.Hazardous with moderate risks
    3.Low Risk
    4.Ok
    5.Not Applicable

  • 1. Flammables (fire/ explosion)

  • Hazard & Location:

  • Add media

  • 2. Hot Work (torch, Cutting, Welding)

  • Hazard & Location

  • Add media

  • 3. Work at Height (fall protection)

  • Hazard & Location

  • Add media

  • 4. Electrical Hazards (Powerlines)

  • Hazard & Location

  • Add media

  • 5. Material Storage

  • Hazard & Location

  • Add media

  • 6. Overhead Hazards

  • Hazard & Location

  • Add media

  • 7. Hoisting / Lifting

  • Hazard & Location

  • Add media

  • 8. Housekeeping

  • Hazard & Location

  • Add media

  • 9. Scaffolds

  • Hazard & Location

  • Add media

  • 10. Ladders

  • Hazard & Location

  • Add media

  • 11. Hazardous Materials (WHMIS)

  • Hazard & Location

  • Add media

  • 12. Power Tools

  • Hazard & Location

  • Add media

  • 13. Mobile Equipment

  • Hazard & Location

  • Add media

  • 14. Traffic Control (barricades / restrictions)

  • Hazard & Location

  • Add media

  • 15. Extreme Temperatures (hot / cold)

  • Hazard & Location

  • Add media

  • 16. Compressed Gas Cylinders

  • Hazard & Location

  • Add media

  • 17. Sewer / Drain Openings

  • Hazard & Location

  • Add media

  • 18. Sky Lights

  • Hazard & Location

  • Add media

  • Other Hazards

  • Explain

  • Hazard rating

  • Add media

  • General media:

Site Details

  • Work Area Isolated:

  • Roof Access Location:

  • Chute Set-up / Garbage Removal:

  • Fire Protection:

  • Propane Tank & Hoses:

  • Building Protection:

  • Special Customer Requirements:

  • Load Requirements of Deck:

  • General media:

Fall Protection To Be Used

  • Guardrails (ladder, hoist, chute & as required at perimeter)

  • Warning Lines

  • Travel Restraint (anchor 800lbs per person)

  • Fall Arrest (anchor 5000lbs per person)

  • General media:

Worksite Hazard Assessment Correction Form

  • Crew Members:

  • Item # / Priority / Recommended Action / Action Taken -Date / By Whom

  • General media:

  • Above Items Discussed With Crew

  • Date:

  • Manager's Signature:

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.