Workplaces and even homes are bound to have some dangers to people who live or work in them. In order to determine the danger or the safety of such places, a hazard assessment form is filled and graded. This form is beneficial not only to health and safety regulatory agencies but for companies and home owners who prioritize safety. Here is a sample hazard assessment form.
Hazard assessment form
Hazard Assessment area: __________________ Work area description: _______________
Assessment carried out by: ___________________________ Date: _________________
Description of Hazard ________________________________________________________
Condition and circumstances __________________________________________________
Scale:
1 Very low 2 unlikely 3 average 4 high 5 very high
Hazard assessment
Exposure to hazard 1 ____ 2 ____ 3 ____ 4 ____ 5 ____
Occurrence probability 1 ____ 2 ____ 3 ____ 4 ____ 5 ____
Consequences 1 ____ 2 ____ 3 ____ 4 ____ 5 ____
Damage extend 1 ____ 2 ____ 3 ____ 4 ____ 5 ____
Rating 1 ____ 2 ____ 3 ____ 4 ____ 5 ____
Total ________
Recommended Control measures ______________________________________________
_________________________________________________________________________
Notes and Summary ________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Assessor signature _________________________ Date ________________________
Checked by __________________________ Signature___________ Date _______
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