Hazard Assessment

Number of Workers

Location of Work *

Muster Point *

Work To Be Done *

Current Tasks *

Hazards — check each one present, then enter how it will be controlled

Additional Hazard 1

Additional Mitigation 1

Additional Hazard 2

Additional Mitigation 2

Additional Hazard 3

Additional Mitigation 3

Warning Ribbon Required?

Yes No

If Ribbon Required, Explain Why

Working Alone?

Yes No

PPE Inspected?

Yes No

Is there Hazards Remaining?

Yes No

If Yes, Explain What

Are Workers Fit for Duty?

Yes No

Sign — Type your name *

Send a copy to anyone else? (optional, comma-separated)

Your Hazard Assessment has been recorded and emailed.

PetroTechs

Field operations dashboard — forms, inspections, and resources for crews in the field.

Edit this block with your address.

+1 234 567 8910