Formal Hazard Assessment and Control
Assessment performed by:
First Name
Last Name
Assessment Date:
-
Month
-
Day
Year
Date
Work type:
Please Select
Pre-drywall visual review
Postboard BDT
Final testing
Warranty call
Other
Other:
Please describe
Reviewed by:
First Name
Last Name
Client:
Please Select
Avalon
Calbridge
Baywest
Homes by Dream
Minto
Morrison
Jayman
Sunset
Other
Other:
Name of client
Site address:
Types of Hazards present:
Hazard Present
Severity
Likelihood
Risk (automatically calculated)
Controls
Date Implemented
Comments
Working alone
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Working at height
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Working in confined space
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Fumes (i.e. paint)
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Loud noises
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Slippery/Wet Surfaces
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Temperature - cold
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Temperature - heat
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Construction debris
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Restricted access (i.e. front steps not installed)
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Other - please describe in comments
Yes
No
1 - Could cause discomfort
2 - Could result in hospitalization
3 - Could kill or permanently disable, immediately or over time
1 - Possible
2 - Probable
3 - Very likely
Elimination
Engineering
Administration
PPE
Calculation
Calculation
Calculation
Calculation
Calculation
Calculation
Calculation
Calculation
Calculation
Calculation
Calculation
Personal Protective Equipment (PPE) required for the job
Yes
No
Comments
CSA approved safety shoes
Hard hat
Hi-viz vest
Ventilation
Occupational noise exposure
Hazardous waste
Electrical protective equipment
Hand protection
Personal fall protection systems
Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Submit
Should be Empty: