Step Hazard Assessment
Use this form to systematically assess and document hazards associated with steps and stairways.
Assessor Full Name
*
First Name
Last Name
Assessment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Steps (Building, Floor, Area)
*
Step or Stairway Identification (e.g., Step number, Area label)
*
Type of Step/Stairway
*
Indoor
Outdoor
Other
Observed Hazards (Select all that apply)
*
Slippery surface
Uneven surface
Damaged step
Loose handrail
Obstructions
Poor lighting
Other
Hazard Risk Assessment
*
Rows
Likelihood (1=Rare, 5=Almost Certain)
Severity (1=Minor, 5=Severe)
Step Hazard
1
2
Overall Hazard Rating
*
1
2
3
4
5
Recommendations/Corrective Actions
*
Upload Photo(s) of the Step or Hazard (if available)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Comments or Observations
Submit Assessment
Should be Empty: