Hazard Documentation Worksheet
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1
2HAZARD DOCUMENTATION
Division of Occupational Safety & Health
MS: 44600
WORKSHEET (1 C)
Date/Time
WAC #
Classifi. Citation #
Item # Grp
Inst
Inspection Report #
Abatement Period
/
/
Description of observed hazards, conditions and practices
Measurements Method of measurement (tape measure, blueprints, employer statement, other)
Occupation
Duration of
Frequency of
# EEs
Exposed employee
hazard
exposure
exposed
Phone number
Address
Equipment Type
Make
Model
SN
Voltage
Amperage
HP
RPMs
Comments (Employee statement. Employer statement. How complied. PPE, guards, controls)
Abatement method to comply
Discussed with employer
regarding abatement assistance.
(Grid on back side of paper)
F418-031-000 hazard documentation worksheet - 1 c 1-07
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