Professional Documents
Culture Documents
Task Hazards (Existing and Potential) Risks Risk Value (Priority) Controls (Include Engineering, Administrative and Are Controls in Place? If not, how and
PPE) when?
Identify the various Identify known and potential hazards for Identify the risk associated Using the matrix below
each task. with each hazard. indicate if each risk is Low, List what is already in place to eliminate or reduce. Deal with hazards which are high-risk and
tasks done at the site. Medium, of High. have serious consequences first.
Keep in mind long-term health hazards. Make sure that you have reduced risks so far as is
Consider the severity and reasonably practicable. Identify who will take the action, when they
You may find that some task These are risks that could the likelihood as though will take the action, and make note of when
affect anyone on your there are no controls. Part of harm reduction is appropriate provision of first-aid.
should be further broken out in a the action is completed.
worksite.
Job Hazard Analysis (JHA). Do the controls meet legislative requirements?
Severity (1-4)
How do your controls compare to best practices?
Task Hazards Risks Risk Value Controls Are Controls in Place? If not, how and
when?
Severity
Likelihood
Risk Level
Hazard Assessment Form for use by all U
Hazard Assessment Form for use by all U
Hazard Assessment Form for use by all U
Hazard Assessment Form for use by all U
Name of Person who conducted the assessment Signature Date
Risk Level > 11, High Risk (take immediate action to eliminate the risk or implement appropriate controls to lower the risk)
= 4 11, Medium Risk (take timely action to implement appropriate controls to lower or minimize risk)
< 4 Low Risk (continued operation is permissible with minimal controls)
Instructions: