Heat Stress Risk Assessment Form
Assess workplace heat-stress exposure, contributing factors, and controls to determine risk and recommended actions.
Worksite / Location
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Job or Task Being Assessed
*
Environmental Heat Conditions
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Mild (comfortable, <25°C)
Moderate (warm, 25–30°C)
Severe (hot, >30°C)
Other (specify)
Physical Workload Intensity
*
Light (e.g., sitting, light hand work)
Moderate (e.g., walking, lifting light loads)
Heavy (e.g., shoveling, carrying heavy loads)
Clothing or PPE Worn
*
Light, breathable clothing
Standard work uniform
Heavy or impermeable PPE
Other (specify)
Hydration and Rest Break Availability
*
Frequent water and rest breaks provided
Limited breaks or water access
No scheduled breaks or water access
Duration of Exposure (hours per shift)
*
Existing Heat Stress Controls in Place
*
Engineering controls (e.g., fans, shade)
Administrative controls (e.g., work/rest cycles)
Worker training/education
No controls in place
Other (specify)
Overall Heat Stress Risk Level / Recommended Action
*
Low risk – current controls adequate
Moderate risk – improve controls
High risk – immediate action required
Submit Assessment
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