HEALTH AND SAFETY RISK ASSESSMENT TEMPLATE

PPE

Are PPE requirements sufficient? -Should gloves be required? -Should a face shield be required?

Safe | At Risk | N/A

Is PPE supplied adequate for the task? -Previous injuries when using current PPE? Why? -PPE being replaced excessively? (e.g. Burn holes, soaked with liquid chemicals, etc.)

Safe | At Risk | N/A

Is PPE being worn properly? -Ear plugs completely inserted into ears -Safety glasses fit properly and pass fit test (gaps no larger than width of finger) -Gloves being worn when handling materials that are sharp, hot, etc.

Safe | At Risk | N/A

PPE supplies readily available to operators (Interview >= 2 employees.)

Safe | At Risk | N/A

Tools/Machinery/Equipment

Are all tools in good working condition? -Held together with tape? -Excessive noise/vibration? -Requires excessive manual manipulation?

Safe | At Risk | N/A

All existing guarding in place? -Guards laying on the floor? -Bolts/Screws missing from fixed guarding? -Guards shifted causing open point of operation?

Safe | At Risk | N/A

Existing guarding sufficient in preventing access to the point of operation? -Gaps in guarding too large? -Use of chains as barrier guarding? -Interlocked/Presence sensing devices not working properly? -No guard installed where it should exist?

Safe | At Risk | N/A

Machinery working properly and not causing regular manual manipulation? -Frequent breakdowns causing manual work? -Machinery producing excessive noise/vibration due to disrepair?

Safe | At Risk | N/A

Machinery design/layout inherently hazardous? -Congestion created in design? -Equipment no longer safest design for the process? -Can a hazardous piece of equipment be eliminated from the process/work area?

Safe | At Risk | N/A

Hazard Communication

Employees know how to find MSDS and understand the hazards of the chemicals they work with. (Interview >=2 employees)

Safe | At Risk | N/A

Ventilation adequate for the airborne health hazards? -Industrial hygiene sampling results on file? -Employee complaints about “fumes” or “nausea/dizziness”

Safe | At Risk | N/A

Chemicals are stored in proper containers and labeled properly? -Secondary containers that are not in control of current shift labeled with HMIS label or equivalent? -Labels legible and accurately indicates the chemical that is inside the container?

Safe | At Risk | N/A

Incidental spills cleaned up immediately? -No evidence of spills being left? -Chemicals being tracked on employees’ shoes and/or mobile equipment?

Safe | At Risk | N/A

Chemicals stored properly? -Flammable materials not in use stored in proper cabinet/safety container? -Incompatible materials stored away from each other?

Safe | At Risk | N/A

Walking/Working Surfaces and Fall Protection

Proper labels in place and legible? -Portable ladders and stairways require labeling indicating weight limits.

Safe | At Risk | N/A

Floors and work platforms free of excessive debris and clutter? -Excessive oil, trash, manufacturing byproducts, etc. in the work are? -No items stored on stairs?

Safe | At Risk | N/A

Handrails secure and free of excessive defects? -Heavily damaged handrails that require replacement? Loose? Broken welds? Bent handrails and/or toe boards? -Handrails do not contain excessive oil/grease?

Safe | At Risk | N/A

Handrails installed where a fall from a height of four feet or greater exists?

Safe | At Risk | N/A

Fall protection equipment available for working at heights greater than 4 feet from the working surface below it where fall prevention is not available?

Safe | At Risk | N/A

Harnesses, lanyards, SRL, and lifelines maintained in good condition and inspected properly? -Inspection labels present and legible? -Webbing free of frayed, cut or broken fibers? -Quick connect buckles working properly?

Safe | At Risk | N/A

Emergency Response/Fire Protection

Fire extinguishers inspected monthly and unblocked?

Safe | At Risk | N/A

Employees aware of emergency procedures and where assembly areas are? (Interview >=2 employees)

Safe | At Risk | N/A

Eyewash/Safety Shower stations inspected and unblocked?

Safe | At Risk | N/A

Spill kits are available where needed and are equipped/inspected as required?

Safe | At Risk | N/A

Sufficient emergency equipment installed in the area? -Fire extinguishers, eyewash, safety shower, spill kits, alarm pull stations, etc.

Safe | At Risk | N/A

Fire suppression systems not blocked/damaged?

Safe | At Risk | N/A

Mobile Equipment

Equipment inspected per inspection frequency requirements?

Safe | At Risk | N/A

Operators using horns and warning devices where required?

Safe | At Risk | N/A

No passengers on equipment designed for operators only?

Safe | At Risk | N/A

Electrical Hazards/Arc Flash

High voltage signs in place and visible?

Safe | At Risk | N/A

Debris/Tools stored on top of electrical cabinets?

Safe | At Risk | N/A

Electrical cabinets closed and in good repair? -Do the cabinets close securely? -Knock-outs all in place? -Large dents in the housing/door?

Safe | At Risk | N/A

Electrical cabinets not blocked? -Nothing within 36 inches of the front of the cabinet? -Clear access/pathway to electrical cabinets?

Safe | At Risk | N/A

Arc flash signage in place? -Indicates arc flash category?

Safe | At Risk | N/A

Proper arc flash PPE available and in use?

Safe | At Risk | N/A

Hazardous Energy Control (Lockout/Tagout)

Employees expected to conduct lockout trained and equipped properly? -Employees understand their role and requirements? -Employees have locks available if needed?

Safe | At Risk | N/A

Employees locked out during a change over and/or other tasks that require lockout? -All employees who are working on the equipment have their own lock affixed to the proper energy source(s)? -Lockout was verified, stored energy was dissipated and equipment will not operate?

Safe | At Risk | N/A

Energy control procedures exist for all equipment in the area and employees know where to find them?

Safe | At Risk | N/A

Lockout exceptions have been adequately evaluated and determined safe? -Do regular tool/machine adjustments introduce hazards with unacceptable risk? -Other exceptions?

Safe | At Risk | N/A

Crane/Hoist Safety

Inspections completed as per requirements? -Operator inspections completed? -PM’s completed as per the schedule?

Safe | At Risk | N/A

Are employees working under suspended loads?

Safe | At Risk | N/A

Are cranes working within their operating limits? -Capacity not exceeded? -Upper limit switch not used as a stop?

Safe | At Risk | N/A

General Safety and Housekeeping

Trash, debris, and equipment not left laying around?

Safe | At Risk | N/A

Equipment free of excessive dust, oil and/or soot?

Safe | At Risk | N/A

Floor surfaces covered in oil/dust covering the painted surface?

Safe | At Risk | N/A

General tripping hazards due to housekeeping, equipment layout, and/or workstation design?

Safe | At Risk | N/A

Signature and Finalization

I have completed this assessment to the best of my knowledge. This audit is not intended to identify all safety and health hazards, but to identify all visible/known hazards as of the date printed on the completed assessment. assessment.

Select date

General Comments

Overall Safety Score

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