Job Hazard Analysis Form

Bill Knight Pre-Job Hazard Assessment
Project Information
Date*

MonthDayYear
Date
Project's Physical Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor:*
Safety Rep:*
Check all items that apply to your job:
Type a question*

Communication DeviceFirst Aid Kit / Eyewash / ExtinguisherMSDS Binder / Safety ManualMuster Point / Emergency PlanWashroom FacilityRequired PPEHand / Power Tool GuardsElectrical Cord ConditionAccess / Egress ClearWalkways ClearHousekeepingTag Out ProcedureEquipment InspectionOther Trades on Site
Identify the task and rank the hazards:
Tasks & Hazards*
Muster Point Location:*
Signature:*

Clear
Should be Empty:

Bill Knight Pre-Job Hazard Assessment