Site Hazard Assessment

• Audit Title

• Client / Site

• Location
  Address

• Conducted on

  Date

• Prepared by

Millenium Interiors Daily Hazard Assessment/Inspection

• Names of workers

  Date

Worksite Environment Hazards

• Weather

  Select Windy Rain Snow Ice Cold Heat

  • Windy
  • Rain
  • Snow
  • Ice
  • Cold
  • Heat

• Area Cleanliness

  Safe

  At Risk

  N/A

• Confined Space

  Safe

  At Risk

  N/A

• Slips/Trips

  Safe

  At Risk

  N/A

• Cuts/Scrapes

  Safe

  At Risk

  N/A

• Eye Injury Risks

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Noise Level

  Safe

  At Risk

  N/A

• Air Quality

  Safe

  At Risk

  N/A

• Electrical Hazards/Power Lines

  Safe

  At Risk

  N/A

• Open Pits/Excavations

  Safe

  At Risk

  N/A

• Holes In Floor

  Safe

  At Risk

  N/A

• Workers/Vehicles In Area

  Safe

  At Risk

  N/A

• Welding/Cutting/Grinding In Area

  Safe

  At Risk

  N/A

Ergonomic Hazards

• Repetitive Motions

  Safe

  At Risk

  N/A

• Heavy Lifting

  Safe

  At Risk

  N/A

• Awkward Body Positioning

  Safe

  At Risk

  N/A

Equipment/Power Tools

• Guards On Saws/Grinders

  Safe

  At Risk

  N/A

• Training Powder Actuated Tools

  Yes

  No

  N/A

• Cords In Good Condition

  Yes

  No

  N/A

• Scaffolding/Bakers

  Safe

  At Risk

  N/A

• Tagged/Visual Inspection

  Yes

  No

  N/A

• Braces

  Safe

  At Risk

  N/A

• Wheels

  Safe

  At Risk

  N/A

• Decks

  Safe

  At Risk

  N/A

• Special Conditions/Comments

  Safe

  At Risk

  N/A

Working At Heights

Please review Fall Protection Plan when: ~ Arriving at a new site ~ Environment changes require alternate plan ~ Close call occurs

• Training In Fall Protection

  Yes

  No

  N/A

• Fall Hazards Identified

  Yes

  No

  N/A

• Workers Above/Below

  Yes

  No

  N/A

• Ladders Angle/Tied Off/Good Shape

  Yes

  No

  N/A

Elevated Platforms

• Training To Operate Lift

  Yes

  No

  N/A

Inspection

• Tires

  Safe

  At Risk

  N/A

• Hydraulic Lines/Wires (do not use hands to inspect)

  Safe

  At Risk

  N/A

• Joints/Lubrication/Pads

  Safe

  At Risk

  N/A

• Labels Readable

  Yes

  No

  N/A

• Anchor Points

  Safe

  At Risk

  N/A

• Controls Working Properly

  Yes

  No

  N/A

• Fuel Level Percentage

  Select 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

  • 10%
  • 20%
  • 30%
  • 40%
  • 50%
  • 60%
  • 70%
  • 80%
  • 90%
  • 100%

• Comments

  Yes

  No

  N/A

Hazards

• Protrusions From Structure

  Safe

  At Risk

  N/A

• Curbs

  Safe

  At Risk

  N/A

• Power Lines/Distance

  Safe

  At Risk

  N/A

• Manholes/Distance

  Safe

  At Risk

  N/A

• Ground Conditions

  Safe

  At Risk

  N/A

• Comments

  Yes

  No

  N/A

Personal Protective Equipment

• Safety Boots

• Hard Hat

• Safety Glasses

• Face Sheild

• High Visibility Vest/Clothing

• Hearing Protection

• Gloves

Emergency

• Muster Point Identified

  Yes

  No

  N/A

• Evacuation Route Plan

  Yes

  No

  N/A

• First Aid Station/Personnel Identified

  Yes

  No

  N/A

• Closest Hospital

  Royal Alex

  Grey Nuns

  Misericordia

  North East Emergency

  University

• Add signature

  Sign