Information

  • Document No.

  • Audit Title

  • Site

  • Conducted on

  • Prepared by

  • Location
  • Associate

  • Department Manager

  • Primary Contact

Section A - Risk Assessment Demographics

  • Select date

  • Entity

  • Unit / Area

  • Division

Section B - Identify the HAZARD & Assessing the Risk

  • Needles/Sharps

  • Analytical /Actions

  • TB Exposure

  • Analytical /Actions

  • Chemical Exposure<br>

  • Analytical /Actions

  • Laser

  • Analytical /Actions

  • Workplace Violence

  • Analytical /Actions

  • Blood/Fluid Exposure

  • Analytical /Actions

  • Lifting patients

  • Analytical /Actions

  • Lifting Material

  • Analytical /Actions

  • Theft

  • Analytical /Actions

  • Patient Falls

  • Analytical /Actions

  • Employee Falls

  • Analytical /Actions

  • Electrical

  • Analytical /Actions

  • Asbestos

  • Analytical /Actions

  • Radiation

  • Analytical /Actions

  • Elopement

  • Analytical /Actions

  • Power Tools

  • Analytical /Actions

  • Overhead tasks

  • Analytical /Actions

  • Driver Safety

  • Analytical /Actions

  • Burns / thermal exposure

  • Analytical /Actions

  • Ergonomics<br>

  • Analytical /Actions

  • Fire

  • Analytical /Actions

  • Gas / Vapor / Fume

  • Analytical /Actions

  • Weather impact

  • Analytical /Actions

Section C- Documentation

  • Photos

  • Corrective Action Plan

Section D - Validation

  • Safety Officer Signature

  • Department Manager Signature

Section E - Communication

  • Forward to

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