Workplace Temperature Risk Assessment Form
Assess temperature-related risks in your workplace using this standard evaluation form.
Work Area/Location
*
Date of Assessment
*
-
Month
-
Day
Year
Date
Assessor Name
*
First Name
Last Name
Current Temperature Condition
*
Please Select
Cold (<10°C)
Cool (10–18°C)
Comfortable (19–26°C)
Warm (27–32°C)
Hot (>32°C)
Type of Temperature Exposure
*
Direct sunlight
Heated equipment/processes
Cold storage/freezer
Outdoor weather
Poor ventilation
Other
Duration of Exposure
*
Please Select
Less than 30 minutes
30 minutes to 1 hour
1–2 hours
2–4 hours
More than 4 hours
Observed Symptoms or Signs
*
None observed
Sweating
Shivering
Red/flushed skin
Pale skin
Dizziness
Fatigue
Other
Existing Controls in Place
*
Air conditioning/cooling
Heating
Fans/ventilation
Protective clothing
Work/rest schedules
Hydration available
Other
Overall Risk Rating
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Recommended Corrective Actions/Notes
Submit Assessment
Should be Empty: