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Workplace Hazard Assessment Form

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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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

(check name not set)

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

(check name not set)

Probability

(check name not set)

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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