Hazard Analysis - Continued

Hazard Analysis

PROJECT PHASE:_____________________

ANALYZED BY/DATE:_______________________

APPROVED BY/DATE:______________________

ACTIVITY

POTENTIAL SAFETY/HEALTH HAZARDS

PLANNED CONTROLS

List specific controls for each

Identify each principal

List the hazards associated with each

potential hazard (engineering

activity for the project

principal activity.

controls, administrative controls

phase in sequence.

or personal protective equipment).

SAMPLE FORM

EQUIPMENT

JOBSITE INSPECTION REQUIREMENTS

TRAINING REQUIREMENTS

INSPECTIONS

List equipment requiring

List specific jobsite inspection requirements to

List worker training

preoperational or

include identity and qualifications of competent

requirements, including hazard

periodic inspections.

person(s) or other qualified personnel

communication.

performing inspections.

Figure 1