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Pre-Job Hazard Assessment
Complete this Checklist Prior to starting your Job
Name:
Select a date
Job Location:
Scope of Work
Check off the hazards that apply to this Job:
Eye Injury - Worker must wear Safety Glasses
Foot Injury - Worker must wear Safety Boots
Loud Noise - Worker must wear Hearing Protection
Head Injury - Worker must wear Hard Hat
Chemicals - Review SDS, Wear appropriate PPE and Spill Kit on Site
Pinch/Crush - Extra Caution
Working Alone - Notification plan and protocol
Heavy Lifting - Group lifting or Mechanical Device, Pre-Job Stretches, Job Rotation
Equipment - Must be trained on Safe Work Procedures
Electrical Work - Must have lock/tag and trained in lockout procedures
Fire Potential - Fire Extinguisher Available; Proper Clothing
Ladders -Ladder Training
Hot Work - Complete Hot Work Permit and Post
Working at heights above 10 feet - Wear Fall Protection and Conduct Pre-Use Inspection
If there are any other hazards please identify the hazard & your plan or suggestion to eliminate/control the hazard
Has a Pre-Use Inspection of tools/equipment/forklifts/Ladders/PPE been completed?
*
Yes
No
Do you have all PPE to perform the task available?
*
Yes
No
Are all workers trained on applicable Safe Work Procedures?
*
Yes
No
Submit
Thanks for submitting!
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