Title Page
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Where is the inspection being conducted?
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Conducted on (Date and Time)
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Inspected by
References
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The following diagrams have been included as 'guides' only. Please review and use measures that apply to the hazards you are likely to identify.
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Risk Matrix Reference
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Hierarchy of Controls Reference
Hazards Identified #
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Click the "+ Hazard" button each time you identify a potential hazard
Hazard
HAZARD ANALYSIS
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What kind of hazard have you Identified?
- Biological
- Chemical
- Physical
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Describe the hazard
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Photograph the Hazard
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Describe the hazard
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Photograph the Hazard
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Describe the hazard
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Photograph the Hazard
RISK ASSESSMENT
Risk rating
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What's the consequence of not addressing this hazard
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How likely is this to occur?
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Risk rating
Controls
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Select control measures
- Elimination of hazard
- Substitution/different set up required
- Engineering Controls
- Administrative Controls (Training)
- PPE
- Other
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Enter other control measures
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What steps/processes do you recommend taking?
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Is this a significant hazard?
Completion
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Full Name and Signature of the Inspector