• Nature of work

  • Enter work process or flow

  • Process
  • 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

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