Summary
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Complete Site Walk and Identify Hazards
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Site
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Conducted on
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Prepared by
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Signature
Additional Participants
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Participant Name
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Participant Role
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Signature
Hazards
- Hazards Number
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Photos of Hazard
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Short Description of Hazard
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Type of Hazard
- Machine Safety
- Housekeeping
- Stairs, Handrails, Flooring, Structure
- Other
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Equipment Name
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GC_LAC.Element (e.g. 99_88.77) and/or closest GC_LAC.Element
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Hazard Severity
- Extreme- Action Immediately
- High- Action by Close of Business
- Medium- Action within 7 days
- Low- Action as soon as practical
