Daily Project Hazard Assessment
Before Starting any Task Look for and Correct any Potential Hazards
Supervisor *
Date *
Time *
Shift *
Project/Location: *
# in Crew *
Weather *
1. Tasks to be Done *
1. Potential Hazards *
1. Prioritize Hazards# *
1. Plan to Reduce/Eliminate Risk *
2. Tasks to be Done
2. Potential Hazards
2. Prioritize Hazards #
2. Plan to Reduce/Eliminate Risk
3. Tasks to be Done
3. Potential Hazards
3. Prioritize Hazards #
3. Plan to Reduce/Eliminate Risk
Was there any Injuries Today *
Yes
No
Were there any incidents yesterday? *
Yes
No
Give Details (Who, What, When):
1. Name *
1. Fit For Work *
Yes
No
1. PPE Checked *
Yes
1. Buddy Check *
Yes
1. Stretch & Flex *
Yes
1. Injury *
Yes
No
1. Sign Out Initial *
2. Name
2. Fit For Work
Yes
No
2. PPE Checked
Yes
No
2. Buddy Check
Yes
2. Stretch & Flex
Yes
2. Injury
Yes
No
2. Sign out Initial
3. Name
3. Fit For Work
Yes
No
3. PPE Checked
Yes
3. Buddy Check
Yes
3. Stretch & Flex
Yes
3. Injury
Yes
No
3. Sign Out Initial
Supervisor Name (Printed) *
Superintendent Name (Printed) *
Confirmation all information is correct *
Yes, I Confirm
Submit