Hazard Assessment Form Page 2
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2Completing the Hazard Assessment Certification Form
Occupational Safety and Health (OSH) rules require employers to identify hazards
in the workplace that cause or are likely to cause employee injuries. When engineering
or administrative controls are not feasible, employers must assess the workplace to
determine if hazards are present or are likely to be present that require the use of
personal protective equipment.
The hazard assessment certification can be used to complete OSHA requirements
and steps to completing this form are:
1.
Complete the demographics section of the form. OSHA standards require
an assessment of each particular type of work activity at a given location.
An assessment of the same job title that have identical duties and
responsibilities at the same baseyard is permissible.
2.
Perform assessment by initiating a walk-through of the worksite to identify
tasks (column 1) with potential sources of injury such as: clean animal
shelters, trim grass with weedeater, remove/replace vehicle battery, or clear
vegetation from hiking trail with machete. List all tasks that indicate a
source of potential injury. Note: there is a special safety shoes form for
foot protection.
In column 2 indicate the corresponding hazard from column 1, such as:
animal bite/scratch and animal fecal infection; impact/flying rocks, vibration
and noise from equipment; splash from liquid chemical, or acids, smash
fingers; and laceration to arms, hands, and legs from thorns of plants.
3.
Review data of each hazard in column 2 to determine the level, size,
degree or impact of hazard exposure for column 3. For example, the filter
lens shade level and type of eye and face protection varies for various tasks
such as welding, chipping, grinding, groundskeeping, etc. and the level of
hearing protector attenuation required to reduce employee exposure to an
action level of 85 dBA determines the noise reduction rating (NNR) of the
hearing protector selected.
4.
Check the appropriate boxes for part of body and type of protection
required for hazards assessed. Other types may include: knee pads for
working on floors such as carpet laying, sleeves to protect arms from
steam, chemicals, hot items, etc., and chaps to protect legs from
impact/flying objects, thorny bushes and branches, etc.
5.
Complete certification requirements by printing the name of the evaluator,
and with the evaluator signing and dating the form.
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