Hazard Assessment

Number of Workers

Worker 1

Worker 2

Worker 3

Location of Work

Muster Point

Work To Be Done

Custom Work Scope

Current Tasks

Enviromental Hazards

Dust / Mist Fumes
Noise in area
Extreme Temperatures
Spill potential
Waste
Other workers in area
Weather conditions

Ergonomic Hazards

Awkward body position
Over extension
Twisting / Repetitive Motion
Working in a tight area
Lift too heavy / Awkward to lift
Hands not in line of sight
Working overhead

Access / Egress Hazards

Ladders (tied off)
Slips / Trips / Falls
Evacuation

Overhead Hazards

Hole coverings
Tie-off & anchor points
Falling objects
Power lines

Rigging / Hoisting Hazards

Hoisting or moving loads
Tools & Sling
Others working nearby

Personal Hazards

SOP not available for task
Confusing instructions
No training for task
1st time performing the task

Electrical Hazards

Light levels too low
Working near energized equipment
Electrical cords/tool condition
Static & Grounding (bonding)

Transportation Hazards

Narrow/logging road
Heavy traffic
Vehicle stability (high/wide)
Limited/poor visibility
Obstruction on roadway
Road conditions
Flammable substances

Additional Hazard 1
Additional Mitigation 1
Additional Hazard 2
Additional Mitigation 2
Additional Hazard 3
Additional Mitigation 3
Warning Ribbon Required?

Yes No

If Ribbon Required, Explain Why

Working Alone?

Yes No

PPE Inspected?

Yes No

Is there Hazards Remaining?

Yes No

If Yes, Explain What

Are Workers Fit for Duty?

Yes No

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Hazard Assessment

Ergonomic Hazards

Access / Egress Hazards

Overhead Hazards

Rigging / Hoisting Hazards

Personal Hazards

Electrical Hazards

Transportation Hazards

Additional Hazard 1 Additional Mitigation 1 Additional Hazard 2 Additional Mitigation 2 Additional Hazard 3 Additional Mitigation 3 Warning Ribbon Required?

If Ribbon Required, Explain Why

Working Alone?

PPE Inspected?

Is there Hazards Remaining?

If Yes, Explain What

Are Workers Fit for Duty?

Additional Hazard 1
Additional Mitigation 1
Additional Hazard 2
Additional Mitigation 2
Additional Hazard 3
Additional Mitigation 3
Warning Ribbon Required?