Workplace Hazard Assessment Form

Audit

Nature of work

Enter work process or flow

Work Process

Category of hazard identified

other category

List hazards identified

Severity

Sev.PNG

Number of persons who may be exposed to or have contact with the hazard

Number of times persons may be exposed to or have contact with the hazard

Number of times persons may be exposed to or have contact with the hazard

Number of times persons may be exposed to or have contact with the hazard

freq.PNG

Probability

prob.PNG

Significance

Is training required?

Are the controls in place adequate?

Recommendations

Write recommendations for safety planning and purposes

Completion
Full Name and Signature of Inspector

Workplace Hazard Assessment Form Checklist

Hazards associated with job processes and workflows need to be examined and reviewed to determine if existing control measures are effective and sufficient. Start by listing a process and identify the category of hazard (physical, chemical, biological, etc.). Evaluate the severity, frequency, probability of loss, and significance of hazards observed based on the rating guide provided. Site some recommendations for safety planning and purposes.

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Audit

Nature of work

Enter work process or flow

Work Process

Category of hazard identified

other category

List hazards identified

Severity

Sev.PNG

Number of persons who may be exposed to or have contact with the hazard

Number of times persons may be exposed to or have contact with the hazard

Number of times persons may be exposed to or have contact with the hazard

Number of times persons may be exposed to or have contact with the hazard

freq.PNG

Probability

prob.PNG

Significance

Is training required?

Are the controls in place adequate?

Recommendations

Write recommendations for safety planning and purposes

Completion
Full Name and Signature of Inspector