HAZARD IDENTIFICATION AND ASSESSMENT PLAN TEMPLATE

PROBABILIT EXISTING CONTROL LAST EVAL.

CATEGORY / HAZARD LOCATION PERSON(S) AT RISK RISK LEVEL OWNER NECESSARY ACTION START DATE DUE DATE STATUS
Y MEASURE DATE

CHEMICAL HAZARDS

Hazard A High Medium Complete

Hazard B High Low In Progress

Hazard C Medium Low Overdue

PHYSICAL HAZARDS

Hazard A High High Not Started

Hazard B Medium High On Hold

Hazard C Low Medium In Progress

BIOLOGICAL HAZARDS

Hazard A

Hazard B

Hazard C
QUANTITATIVE
HAZARDS
Hazard A

Hazard B

Hazard C

ERGONOMIC HAZARDS

Hazard A

Hazard B

Hazard C
HAZARD IDENTIFICATION PLAN
DATE TO
ACTION DESCRIPTION ASSIGNED TO START DATE DUE DATE NOTES
REVISIT

EXISTING HAZARD IDENTIFICATION

Survey employees

Review historical documents and records of hazards

Conduct and document inspections Internal, insurance carrier, consultants, etc.

Check operating manuals

Review Safety Data Sheets (SDS)

Conduct health and safety committee meetings

NEW HAZARD IDENTIFICATION

Identify regular / routine situations

Identify nonroutine / emergency situations

Develop checklist of hazards to look for Electrical, fire, slip, trip, fall, equipment operation hazards, etc.

DETERMINE AND ASSESS HEALTH HAZARDS

Chemical hazards

Physical hazards

Biological hazards

Quantitative exposure air sampling and/or direct reading tools

Ergonomic hazards Heavy lifting, repetitive motions, etc.

INVESTIGATE INCIDENTS

Create plan for conducting investigations Who, what, where, and when of processes

Conduct necessary training

Investigate near-miss incidents

Identify and analyze root cause of issues

Analyze existing control measures

Create action plan to mitigate future hazards

ONGOING MEASURES

Schedule regular health and safety meetings

Send quarterly or semi-annual surveys to employees

Conduct quarterly or semi-annual inspections

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