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Hazard Assessment
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Name
Email
Date / Time
Date
Time
Location of Assessment
Framing Stage
Main Floor
Second Floor
Roof
***MAIN FLOOR***
Open Excavation
Yes
No
Controls
Barricade
Fence
Snow/Ice
Yes
No
Controls
Salt/shovel
Delay
Open Stairwell
Yes
No
Controls
Barricade
Cover
Cords in Good Working Condition?
Yes
No
Controls
Repair
Replace
Ladders in Good Working Condition?
Yes
No
Controls
Repair
Replace
***SECOND FLOOR***
Perimeter Fall Hazard
Yes
No
Controls
Guardrail
Scaffold
Open Stairwell
Yes
No
Controls
Barricade
Cover
Snow/Ice
Yes
No
Controls
Clear
Delay
Fall Potential
Yes
No
Action
Fall Arrest
Cords in Good Working Condition?
Yes
No
Action
Repair
Replace
Ladders in Good Working Condition?
Yes
No
Action
Repair
Replace
***ROOF***
Perimeter Hazard
Yes
No
Controls
Harness
Toeboards
Snow/Ice
Yes
No
Controls
Clear
Delay
Ladders Secure
Yes
No
Action
Secure
Replace
Fall Arrest Used
Yes
No-Equipment
Action
Rope
Anchor
Equipment & PPE
Heavy Machinery
Yes
No
Controls
Spotter
Exclusion Zone
Telehandler Operator Trained/Certified
Yes
No
PPE Mandatory
High Vis Vest
Steel Toes
Hard Hat
in Layout Trained/Certified
Description of Hazard
Risk Level
Low
Medium
High
Recommended Actions
Submit