Workplace Hazards & Solutions Worksheet



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