4.

3.
2.
1.
Serial No

Areas/
Activities
Company Logo

/ OH&S Hazards
Environmental Aspects

Dust Vapors, Fumes etcAir Emissions (Gases)

Department

Noise

Heat & Injury due to heat

Vibration

Spillage & Slipping

Solid & Liquid Wastes

Effective Date

Land Contamination

Falling objects
HAZARDS IDENTIFICATION FORM

Injuries (major Minor or fatalities)

Reference No

Working at heights & Human Fallings

Fire Hazard

Hazardous Materials

Chemical & Metal Splash

Electric Shock

Trenches, Manhole etcSuffocation & work in confined places i.e.

Page
1 of 2
Revision

Flammable Fuels

Manual Lifting &Handling

 Page
HAZARDS IDENTIFICATION FORM 2 of 2
Company Logo
Department Effective Date Reference No Revision

5.

6.

7.

_____________________
HSE Manager