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Sample Hazard Analysis Checklist

This document provides a hazard and risk management checklist for evaluating jobs and tasks. The checklist covers training requirements, potential hazards, hazard controls, and sign off sections for workers and supervisors.

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hassankhalid.work1
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12 views

Sample Hazard Analysis Checklist

This document provides a hazard and risk management checklist for evaluating jobs and tasks. The checklist covers training requirements, potential hazards, hazard controls, and sign off sections for workers and supervisors.

Uploaded by

hassankhalid.work1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Introduction to Hazard & Risk Management eLearning

Sample Hazard Analysis Checklist Location_________________________________________________

1. Task Analysis Hazard and Risk Review 3. Training Y NA 5. Hazard Control


Date: ________________________________ Fall protection   Eyes:  Eye wash
Company: ____________________________ WHMIS    Glasses/goggle  Face shield
Employee: ____________________________ First Aid   Ears:  Plugs/muffs
Foreman: _____________________________ Powerline awareness   Body:
Job Location: __________________________ Fire extinguisher    Boots  Hard hat
2. Pre-Job Evaluation Y NA Elevated work platform    Fire retardant  Gloves
Job scope understood   Traffic control   Traffic vest  Chaps
Orientation completed   TDG    Welding helmet  Knee pads
Safety equipment available   Forklift   Elevation:  Guardrails
Proper tools available for task   Explosive Actuated tools    Fall protection  Scaffolding
All isolation points identified   Other training:    Overhead prot.  Signage
MSDSs available   ___________________   Environment:
Job procedures reviewed   ___________________    Job rotation  Lighting
Environmental impact review   ___________________    Ventilation  Water
Permits required 4. Potential Hazards Housekeeping:
 Safe work   Eyes:  Particle  Clear work area  Clean up
 Hot work   Ears: Loud noise Fire:
 Confined spaces   Respiratory: Inhalation  Extinguisher  Grounding
 Energized electrical   Body:  UV protection  Fire watch
 Underground    Cuts, sharp edges Additional Controls:
 Waste disposal    Repetitive motion  Proper equipment for task
 Critical lifting    Pinch point  Guards on moving parts
 Other    Overexertion  Tag and lockout required
Housekeeping reviewed    Pressure test and isolation
 Awkward posture
Weather conditions considered  Engineered trench box
   Vibration
PPE requirements reviewed  Utility locates
  Elevation
Inspection checklists complete  Hazard signage
Overhead hazards identified    Falling material
   Overhead work  Communication devices
Excavation hazards reviewed  Material handling equipment
Traffic control plan reviewed    Elevated work
 Shoring or cutbacks
Open holes secured   Environment
 Proper cranes
Slips, trips, falls assessed    Cold stress
 Proper rigging and tag lines
Proper equipment reviewed    Heat stress  Potable water
Lockout reviewed    Poor access/egress Other:
Fire plan reviewed    Inadequate lighting  _________________________
Flammable storage reviewed    Inadequate ventilation  _________________________
Emergency plan reviewed    Weather conditions  _________________________
Other:   Housekeeping  _________________________
________________________    Debris, material, tools  _________________________
________________________   Equipment  _________________________
________________________    Reversing equipment  _________________________
   Moving equipment  _________________________
 Cranes
IF A MORE SPECIFIC JOB/TASK RISK ANALYSIS IS REQUIRED FILL IN BELOW
JOB HAZARDS CONTROL HAZARD CONTROLLED?

Worker Name Signature Worker Name Signature

Supervisor Name ________________________ Signature: ________________________________ Date : _______________

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