Hazard identification and controls report
The purpose of this procedure is to inspect the work site for hazards, to eliminate, isolate or
minimise the hazard.
Person in charge
Location
Job description
Work party details
Work Group Member
Task Responsibility
Initials
Hazard prompt
Personal protection
yes
no
Evacuation
Smoking
yes
no
equipment required?
procedures?
permitted?
Is the equipment you are working on clearly identified? Are there any hazards in getting access
to the site? Can any hazards arise during the job?
Hazard identification and control
Exists
Hazard
Yes
No
Method of Control
(To eliminate, isolate or minimise)
Fall
Power lines
Confined Spaces
Fire
Public Protection
Traffic
Overhead Dangers
Stacked Materials
Insecure Scaffold
Wind
Vehicle Loads
Power leads/ source
Faulty Plant
Others:
Site supervision
(signed)
Scaffolding and Rigging New Zealand (SARNZ), 2009.
Date