Scribd
Upload
120 views

Hazard Assessment and Control Report Template

This document provides instructions for completing a Hazard Assessment and Control Report. It outlines how to [1] identify health and safety hazards associated with position-based tasks, [2] analyze the risk of each hazard by evaluating frequency, likelihood, and consequence of exposure, and [3] determine the degree and classification of risk to establish control priorities. Control measures should then be identified and include engineering, administrative, or personal protective equipment options to minimize risks. Completed reports should be submitted to the Health, Safety and Environment department.

Uploaded by

Alex Ambomo
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
120 views

Hazard Assessment and Control Report Template

This document provides instructions for completing a Hazard Assessment and Control Report. It outlines how to [1] identify health and safety hazards associated with position-based tasks, [2] analyze the risk of each hazard by evaluating frequency, likelihood, and consequence of exposure, and [3] determine the degree and classification of risk to establish control priorities. Control measures should then be identified and include engineering, administrative, or personal protective equipment options to minimize risks. Completed reports should be submitted to the Health, Safety and Environment department.

Uploaded by

Alex Ambomo
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

Hazard Assessment and Control Report Instructions

Identify health and safety hazards

1. Identify position-based / process-related tasks in column 1 (Tasks, step-by-step).


2. Identify the type of physical, chemical, biological or psychological hazard related to the task(s) in column 2 (Potential Hazards).

Analyze the risk* associated with each hazard


Risk analysis is an evaluation of risk factors associated with each identified hazard to determine the degree of risk the hazard poses to employees.
Risk analysis helps the supervisor determine the type or number of controls needed to eliminate, reduce or minimize the risk. Use the ratings
below to complete 3, 4, and 5 (Frequency, Likelihood & Consequence).
*For obvious high hazards activities (e.g. working at height) an independent Hazard Assessment and Control Report must be completed.

Frequency (3) – How often is the task Likelihood (4) – How likely is it that the exposure will result Consequence (5) – How severe will the
performed? in loss such as illness, injury or property damage? loss be if no controls are in place?
Description Value Description Value Description Value
Continuous Task occurs multiple 5 Expected Known to occur multiple times a 5 Fatality Fatal injury 5
times per day year
Frequent Task occurs once per 4 Likely Known to occur once a year 4 Major Long-term disability 4
day (permanent)
Infrequent Task occurs at least 3 Occasional Known to occur once every 5 years 3 Moderate Short-term 3
once per week disability (lost-time
injury)
Occasional Task occurs at least 2 Not likely Known to occur once every 10 2 Minor Medical aid without 2
once per month years loss of time
Rare Task occurs once per 1 Unexpected Should never happen 1 First Aid First aid injury 1
year or less

2019-02-14 1 of 3
After you have completed the risk analysis, use the ratings below to complete columns 6 and 7 (Degree and Classification of risk). This is the
pre-control risk rating. i.e. with no controls in place, what are the risks.

Degree of Risk (6) Classification of Risk (7)


Multiply the score for Description Total Value
Frequency, Likelihood and Not acceptable Work may not begin. Contact MacEwan HSE to arrange consultation. >80
Consequence High Work may begin with controls in place as long as it is reduced to a lower classification of 60 – 79
risk in the midterm through reasonable and practicable options.
FxLxC=
Medium Work may begin with controls in place as long as it is reduced to a lower classification of 40 – 59
risk in the long term using low resource, reasonable and practicable options.
Low Work may begin with controls in place. 20 – 39
Acceptable Work may begin with controls in place. Considered negligible risk. 1 – 19

This hazard classification established the priority for the implementation of control measures.

In column 8, identify what control measure(s) are in place to minimize the risk of the hazard. Examples of different types of control measures are
outlined in the following definitions.

Control(s) (8)
Engineering This type of control eliminates the hazard by modifying the equipment, chemical or process. Or, it substitutes, isolates,
encloses, guards or ventilates the hazard. (e.g. fume hood)
Administrative This is a process to control hazards that are not eliminated by engineering controls (e.g. training, standard operating
procedures)
Personal Protective Equipment Equipment used or clothing worn by personnel to protect them from safety hazards associated with conditions at the
workplace (e.g. gloves, hard hat)

2019-02-14 2 of 3
Hazard Assessment and Control Report

Position/Process Title:
Department:
Completed By:
Date:
Participants: (List individuals who took part in this process, First Last Name)

PRE-CONTROL (3-7)
Control in
TASKS (1) POTENTIAL HAZARDS (2) FxLxC Risk Rating Risk CONTROL(S) (8)
Place (Y/N) (9)
(3) (4) (5) (6) Classification
(7)

Hazard Assessment Lead Signature:

***Once signed, submit this form to HSE online here.


If you have any questions or concerns, please contact the Health, Safety and Environment at [email protected] with the subject line: Hazard
Assessment and Control Report

2019-02-14 3 of 3

You might also like