Hazard Assessment Form
Hazard Assessment Form
Please fill out this form to help us identify and address potential hazards.
Date
Assessor
Phone Number
Location/Area Assessed
Type of Hazard(s) Identified
Select all that apply:
-
Slip/Trip/Fall
-
Electrical Hazard
-
Chemical Exposure
-
Equipment Malfunction
-
Fire Hazard
-
None
-
Hazard Description
Immediate Actions Taken (if any)
Recommendations for Mitigation
Supporting Documents
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