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Hazard assessment
*
Indicates required field
Name
*
First
Last
Please select work week
Address
*
Job #
*
1 - Protective Equipment
*
Steel toes
Eye protection
Hearing protection
Gloves
Dust masks
Face shield
Safety vest
Hard hat
All of the above
2 - Site Access / Construction
*
Clean, level ground
Adequate ramps
adequate ladders
Icy, wet or muddy
3 - Housekeeping
*
Clear walkways
Clear work areas
Clear access and landing
4 - Material storage
*
Properly located
Safely piled, stacked or bundled
Properly moved or lifted
Secure from wind
All of the above
N/A
5 - Guardrails
*
Located where required
Properly constructed
Adequately secured
N/A
6 - Emergency preparedness
*
Safety rules posted
Emergency contracts posted
Fire extinguishers available
First aid Kit
7 - Fall protection
*
Properly worn
Safe usuable condition
No visible signs of wear
N/A
8 - Scaffolding
*
Properly erected
Properly secured
Properly planked
Guardrails if required
Proper access to platform
N/A
9 - Elevated work platform
*
Properly used
Safe usable condition
Acceptable loading
Fall protection
N/A
10 - Power tools
*
General condition
Proper guards, cords, PPE
Extension cords in good working condition
11 - Trade hazards
*
Excavation / Cribbing
Framing
Roffing
Electrical
Plumbing
Mechanical
Insulation
Drywall / taping
Other exterior trades
N/A
12 - Ladders
*
Secured
Proper angle (extension ladders) 4 to 1 ratio
Apropriate size and type
Safe usable condition
Proper usage
N/A
13 - Additional Hazards (Must provide min 1)
*
14 - Additional notes
*
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