Free checklist · 29 CFR 1910.132(d) / General Duty Clause 5(a)(1)
Workplace Hazard Assessment Form: Identify Hazards and Actions
A workplace hazard assessment records what can hurt people in an area or task and what you will do about it. This form helps supervisors review surfaces, machinery, chemicals, environmental conditions, ergonomics, and PPE. It also prompts risk ratings, assigned controls, corrective action deadlines, and supervisor review so findings lead to specific work.
The full workplace hazard assessment template
Workplace Hazard Assessment Form. Blanks in [brackets] are for your own details.
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A general workplace hazard assessment form to identify, evaluate, and document physical, chemical, ergonomic, electrical, fire, and PPE hazards across an area or job task. Satisfies the PPE hazard assessment requirement and supports the General Duty Clause.
Administrative
- 1Area/department and assessed task clearly identified (with assessor name and date)
- 2Assessment reviewed and signed by supervisor and scheduled for periodic reassessment
Slips/Trips/Falls
- 3Walking/working surfaces free of trip hazards, spills, holes, and uneven flooring
- 4Work performed at heights >4 ft (general industry) / 6 ft (construction) has fall protection in place
Egress
- 5Aisles, exits, and egress paths are unobstructed and clearly marked
Electrical
- 6Electrical cords, outlets, and panels are undamaged with required clearances maintained
Fire
- 7Fire extinguishers accessible, charged, and inspected; ignition sources controlled
Chemical
- 8Hazardous chemicals identified, labeled, and SDS accessible (HazCom program in place)
- 9Chemical storage compatible, ventilated, and secondary containment provided where required
Machinery
- 10Machine guarding installed on points of operation, pinch points, and rotating parts
- 11Lockout/tagout procedures available and followed for servicing and maintenance
Equipment
- 12Powered industrial trucks/forklifts operated by trained operators in designated lanes
Ergonomics
- 13Manual lifting, repetitive motion, and awkward postures evaluated for ergonomic risk
Physical
- 14Noise levels assessed; hearing protection provided where exposure exceeds 85 dBA TWA
Environmental
- 15Heat/cold stress, lighting, and air quality conditions are acceptable for the task
Confined Space
- 16Confined spaces identified, evaluated, and permit program applied where required
PPE
- 17Required PPE selected based on identified hazards (eye, hand, foot, head, respiratory)
- 18PPE is available, properly fitted, maintained, and worn by exposed employees
Biological
- 19Biological/sanitation hazards (bloodborne pathogens, waste) controlled where present
Risk Rating
- 20Each identified hazard assigned a risk rating (likelihood multiplied by severity)
Controls
- 21Control measures assigned per the hierarchy of controls (eliminate, substitute, engineering, administrative, PPE)
Corrective Action
- 22Corrective actions documented with responsible person and target completion date
The printable copy adds Pass, Fail and N/A columns with Inspector, Supervisor review and Date lines.
A starting point, not legal advice. Have a qualified person check it against your site, your state's rules and the standard before you rely on it.
Workplace hazard assessment: when it’s needed
Use this assessment before assigning PPE and whenever changed processes, equipment, or tasks introduce different exposures. Under 29 CFR 1910.132(d)(1), employers must evaluate workplace hazards that require PPE. Section 1910.132(d)(2) separately requires written certification identifying the workplace, certifying person, assessment dates, and the document as a certification of hazard assessment. Add those certification details to this starting form. Its broader hazard review also supports attention to recognized serious hazards addressed by General Duty Clause section 5(a)(1) where no specific standard applies.
How to use this workplace hazard assessment template
- Define the department, work area, and actual tasks being assessed, including nonroutine cleaning and maintenance activities.
- Walk the area with employees who perform the work, and record exposures rather than checking boxes from memory.
- Rate each finding using your chosen likelihood and severity scale, then select controls before relying on PPE.
- Assign a named owner and target date to each corrective action, and verify the fix in the field.
- Complete the required PPE assessment certification details and have a knowledgeable reviewer check the assessment before issuing equipment.
Before you use this workplace hazard assessment template: what to fill in and check
- Workplace boundaries, assessment dates, and the identity of the person certifying the PPE evaluation.
- Actual chemical inventory, measured exposures, equipment guards, and task-specific PPE selection criteria.
- Risk scoring definitions, corrective action owners, and triggers for reassessing changed work.
- Additional requirements in states that run their own OSHA programs (state plans).
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Workplace hazard assessment questions
What must a written PPE hazard assessment certification include?
The certification must identify the workplace evaluated, the person certifying the evaluation, and the assessment date or dates. It must also identify the document as a certification of hazard assessment under 29 CFR 1910.132(d)(2). An assessor name and a supervisor signature alone may not establish all those elements. Label the certification clearly and connect it to the hazards and PPE decisions.
Is a workplace hazard assessment the same as a job hazard analysis?
Not quite. An area assessment looks across conditions such as traffic, storage, chemicals, and equipment. A job hazard analysis usually breaks one job into steps and identifies hazards and controls at each step. Use the area review to find trouble spots, then examine complicated or higher-risk tasks in more detail with the workers involved.
Does OSHA require a numerical risk score for every workplace hazard?
The PPE assessment rule does not prescribe a likelihood-times-severity scoring system. The form uses that approach to help you prioritize findings, not as a substitute for applying a specific standard. Define your scale consistently, and correct immediate dangers without waiting for a score. A low rating does not cancel an applicable protective requirement.