Workplace Hazards & Solutions Worksheet For use with the Workplace Hazard Basics Course Hazard Source (Object, Activity, or Location): Date: Company: Work Area: Evaluator: Hazards (How can someone get hurt?) Caught in or between Fire or explosion Slip or Trip (machinery, soil, etc.) Chemical or substance Hit by or against Sprain or Strain (blood, dust, etc.) (vehicle, debris, etc.) (lifting, etc.) Electrical Hot environment or surface Other: Falls Noise Other: (from elevation or at same level) Describe each hazard noted: Hazard Solutions (What can change to make it safer?) Change Change Change something about the what’s used how work’s done (safer chemical, materials, or (safer method or tool, etc.) location (improve ventilation, limit equipment, etc.) access, etc.) Describe the changes (hazard solutions) for each hazard: Personal Protective Equipment (PPE) (when necessary) Eye Face Fall Protection Foot Hands Hearing Torso Respirator Other Describe PPE and when to use it:
Workplace Hazards & Solutions Worksheet For use with the Workplace Hazard Basics Course Hazard Source (Object, Activity, or Location): Date: Company: Work Area: Evaluator: Hazards (How can someone get hurt?) Caught in or between (machinery, soil, etc.) Fire or explosion Slip or Trip Chemical or substance (blood, dust, etc.) Hit by or against (vehicle, debris, etc.) Sprain or Strain (lifting, etc.) Electrical Hot environment or surface Other: Falls (from elevation or at same level) Noise Other: Describe each hazard noted: Hazard Solutions (What can change to make it safer?) Change what’s used (safer chemical, materials, or equipment, etc.) Change how work’s done (safer method or tool, etc.) Change something about the location (improve ventilation, limit access, etc.) Describe the changes (hazard solutions) for each hazard: Personal Protective Equipment (PPE) (when necessary) Eye Face Fall Protection Foot Hands Hearing Torso Respirator Other Describe PPE and when to use it:
F417-271-000.docx