HAZARD IDENTIFICATION FORM

Identified By:	[Your Name]
Date:	[Month Day, Year]

1. Hazard Description:

Hazard Type:

• Chemical

• Physical

• Ergonomic

• Others (Please specify):                               

Description:

                                                                                                                                                                                                                                                                                                                                                                                                                           

Location:

                                                                                        

2. Potential Impact:

Severity:

• Low Risk

• Medium Risk

• High Risk

Likelihood:

• Low Risk

• Medium Risk

• High Risk

Initial Controls (if any):

                                                                                                                                                                                                                                                                                  

Existing Measures:

                                                                                                                                                                                                                                                                                  

3. Additional Comments/Notes:

                                                                                                                                                                                                                                                                                                                                                                                                                           

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