DESCRIBE THE HAZARD IN DETAIL
IS APPLICABLE PROTECTIVE MEASURES (PPE, ETC.) CURRENTLY AVAILABLE?
IS ANY EQUIPMENT INVOLVED IN THE HAZARD
DESCRIBE WHAT IS CURRENTLY BEING DONE TO MITIGATE THE HAZARD
DO YOU WISH TO MAKE ANY SPECIAL REQUESTS AT THIS TIME?
SSB HAZARD REPORT
UTILIZE THIS FORM TO REPORT TO THE HSE DEPARTMENT ANY UNUSUAL OR NEW HAZARDS EMPLOYEES ARE EXPOSED TO
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended
take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or
or other applicable laws. You should also seek your own professional advice to determine if the use of such
permissible in your workplace or jurisdiction.