Job Hazard Analysis Form
Complete this Job Hazard Analysis Form to document job details, identify hazards, and outline control measures.
Job/Task Title
*
Job Location
*
Date of Analysis
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Person Completing Analysis
*
First Name
Last Name
Job/Task Description
*
Main Steps Involved (list key steps, one per line)
*
Hazards Identified
*
Slips, trips, and falls
Electrical hazards
Chemical exposure
Ergonomic risks
Mechanical hazards
Other
Risk Level
*
Low
Medium
High
Control Measures / Actions to Mitigate Hazards
*
Supervisor/Manager Review Name
First Name
Last Name
Submit
Should be Empty: