Environmental Hazards
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Select
Spill Potential
Weather Condition
MSDS's / Eyewash
Ventilation / Inhalation
Heat / Cold Stress
Other Workers in Area
Cuts / Sharp Edges
Inadequate Lighting
Housekeeping / Hygiene
Poor Access / Egress
UV Exposure / Chemical Burns
Barricades / Guardrails
Spill Potential Weather Condition MSDS's / Eyewash Ventilation / Inhalation Heat / Cold Stress Other Workers in Area Cuts / Sharp Edges Inadequate Lighting Housekeeping / Hygiene Poor Access / Egress UV Exposure / Chemical Burns Barricades / Guardrails
Ergonomic Hazards
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Select
Working in Tight Areas
Working Above Your Head
Repetitive Moition
Pinch Point / Workstation
Overexertion / Awkward
Back / Knee Stress / Pulling
In Line of Fire
Confined Space / Water
Lifting / Carrying / Pushing
Rigid Postures / Vibration
Overloading Spine / Joints
Ladders / Platforms
Working in Tight Areas Working Above Your Head Repetitive Moition Pinch Point / Workstation Overexertion / Awkward Back / Knee Stress / Pulling In Line of Fire Confined Space / Water Lifting / Carrying / Pushing Rigid Postures / Vibration Overloading Spine / Joints Ladders / Platforms
Personal Limitations Hazards
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Select
Instructions Clearly Understood
Trained to Use Tool and Perform Task
Distraction in the Work Area
Working Alone (communications)
Lift Heavy/Awkward Position
External Noise Levels / Hearing
Physical Limitations / Positioning
Visibility / Accessibility
Respirator Fit Test
Reversing Vehicles /Traffic
Safety Compliance / Signage
Area Secure / Whipchecks
Instructions Clearly Understood Trained to Use Tool and Perform Task Distraction in the Work Area Working Alone (communications) Lift Heavy/Awkward Position External Noise Levels / Hearing Physical Limitations / Positioning Visibility / Accessibility Respirator Fit Test Reversing Vehicles /Traffic Safety Compliance / Signage Area Secure / Whipchecks
Activity Hazards
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Select
Grinding / Welding
Burn / Heat / Spark Sources
Compressed Gases
Energized Equipment / Cords / Tools
Operator Seat Belts
Equipment Guards / Parts
Lockout / Black / Block / Blind
Airborne Particles / Smoking
Critical Lift / Move / Placement
Slip / Trip Potential
Scaffolds / Toe Boards
Proper Rigging / Tag Lines
Working at Heights
Personal Protective Equipment
Confined Space
Grinding / Welding Burn / Heat / Spark Sources Compressed Gases Energized Equipment / Cords / Tools Operator Seat Belts Equipment Guards / Parts Lockout / Black / Block / Blind Airborne Particles / Smoking Critical Lift / Move / Placement Slip / Trip Potential Scaffolds / Toe Boards Proper Rigging / Tag Lines Working at Heights Personal Protective Equipment Confined Space
Concerns & Follow Up Action
Concerns
Attendance
Name Of Supervisor
Sign
Name of Worker
Name of Worker
Sign
link copied
Peter Affum
Urbandale Tool Box Talk Records
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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.