Workplace Hazard Assessement

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Work to be completed

• 1= Not Applicable 2= Safe 3= Minor Danger 4= Serious Danger 5= Immediate Danger

• Weather Conditions (Is the weather a hazard?)

• Overhead Dangers (Are there any dangers from material or other workers on site?)

• Excavations (Are there any open excavations on site to be aware of?)

• PPE required - If so, identify. (Do you require any PPE due to cutting material or danger from other workers? Are safety glasses required because of drilling or sawing?)

• Other Workers (Are there other workers on site and is the work they are doing a <br>hazard?)

  Yes

  No

  N/A

• Ramps/ Stairs (Is there a ramp or stairs going into the site? Is it in good condition? <br>Are there stairs going into the basement?)

  Good

  Fair

  Poor

  N/A

• Floor Openings (Any openings in the floor that could be dangerous?)

  Pass

  Fail

  N/A

• Guardrails (Are there guardrails in place on all stairs on site?)

  Pass

  Fail

  N/A

• Lifting (Are there lifting material that could result in a strain? Should there be 2 people moving the item?)

• Hazardous Chemicals (Are you using chemicals and do you have an MSDS sheet for it?)

• Site Cleanliness (Is the worksite clean?)

• Working Alone? (If so cellphone must be charged and 1 other team member aware of the location & work at hand)

• Comments

Sign Offs

• Work area Picture.

  Media

• Sign Off

  Sign