Hazard Assessment Instructions
Prior to conducting a job hazard assessment it is recommended that you review the OSHA guide for an understanding of the process and required results.
Once you are familiar with the process complete the Hazard Assessment Form.
Additional Instructions for Completion:
You may have some hazards that may or may not require the use of (PPE) Personal Protective Equipment. In any case review the hazards found with your immediate supervisor and determine what can be done about the hazard(s). All hazards identified will be reviewed for engineering controls (Example: Hand rails, exhaust systems…) and/or administrative controls (Example: Safety cones, warehouse traffic patterns, signs…) to eliminate or reduce exposure to the hazard(s).
1. Room/Workplace: Fill in the specific room number (if numbered) or the name of the room or space where the assessment is being performed.
2. Facility Name: Fill in school name, building name, facility name.
3. Assessor’s Name: Fill in the name of the person doing the assessment. (Please Print)
4. Location Code: Fill in your 3 or 4 digit location code number.
5. Assessment Date(s): Fill in the date(s) when the assessment is being performed.
Column (b): Are chemicals used? (Yes or NO)
Column (c): Use this column to list the hazards given on the MSDS sheet for that chemical.
Column (d): Does the activity or activities create a physical hazard? (Yes or NO)
Column (e): Use this column to identify the sources of the hazards from list below. (Note: This list is not intended to be complete; it is to provide some examples of what to look for in your workplace)
Authorized Signature: Signed by the Assessor.
Column (a): Use this column to identifying any activity or activities that may expose you or others to one or more hazards found in your workplace.
Column (f): Use this column to list the proper PPE by using MSDS, operator’s manuals or common industry safety practices. Date: Date the assessment is being certified.
- Impact (falling objects, struck-by hazards…)
- Puncture and cuts (tools, knives, nails, wire rope, sheet metal…)
- Crushing (gears, shifting loads…)
- Chemical (solvents, corrosives, paints…)
- Heat/Cold (welding, burning, environmental temperatures…)
- Burns (thermal, chemical…)
- Vibration (pneumatic tools…)
- Dust (heavy metals, silica…)
- Light (optical) radiation (arc welding, lasers…)
- Excessive noise (abrasive blasting, scaling, grinding, metal straightening…)
- Falling (ladders, aerial lifts, elevated area…)
- Motion (machinery, tools, conveyors…)
- Electrical (light fixtures, control panels, bare wires…)