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Entering Hazard Analysis for
[#] Job Name
Team Members
Sequence of Basic Job Steps
Recommended Safe Job Procedure
Potential Accidents or Hazards
Required and/or recommended Personal Protective Equipment
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Only check off items below if there is an issue or defect.
General Condition
Warning Devices
Fluids
Miscellaneous
Inspection Status
Remarks
Repairing Operator
Immediately notify your supervisor of all medical needs & damages.
Turn report in daily to office.
Event Type (check all that apply)
Property Damage?
Event Work Related?
Employee Wearing Proper PPE?
Name(s) of Other Persons / Witnesses
Employee Section
Summarize incident, event or observation.
Date and Time of Incident
Defaults to now — change if the incident happened earlier.
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Task Hazard Analysis
Required and/or recommended Personal Protective Equipment
Sequence of Basic Job Steps
Potential Accidents or Hazards
Recommended Safe Job Procedure
Team Members