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"Hazard Assessment Template"

"Workplace hazard assessment form: area/location, hazard categories, description, current controls, risk rating, corrective action, priority."

Apr 13, 2026all

Every compliance program in existence rests on one foundational question: what are the hazards?

Not what hazards exist in your industry. Not what hazards the template lists. What hazards exist in YOUR workplace, on YOUR floor, with YOUR equipment, in YOUR operations, affecting YOUR people right now.

If you get the hazard assessment right, everything downstream — your controls, your training, your incident prevention — has a fighting chance. If you get it wrong, or if you phone it in, you are building your entire safety program on sand. And I promise you, the inspector will find the cracks.

This template structures a proper hazard assessment. But I am going to do more than hand you a form. I am going to walk you through how to actually conduct the assessment, what to look for in each category, and where businesses consistently fool themselves into thinking they have fewer hazards than they do.

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Section 1: Assessment Information

| Field | Entry |
|-------|-------|
| **Assessment Number** | HA-[YEAR]-[SEQ] (e.g., HA-2026-003) |
| **Assessment Date** | |
| **Assessment Type** | [ ] Initial (first assessment) [ ] Periodic (scheduled) [ ] Triggered (incident, complaint, change) |
| **Facility/Location** | Full address and site name |
| **Area(s) Assessed** | Specific areas within the facility |
| **Assessor Name** | |
| **Assessor Title** | |
| **Assessor Qualifications** | |
| **Employee Participants** | Names and roles of employees who participated |
| **Assessment Method** | [ ] Physical walkthrough [ ] Employee interviews [ ] Record review [ ] Job hazard analysis [ ] Combination |

Guidance Notes

  • Conduct assessments during active operations. An empty warehouse on a Saturday morning has different hazards than a warehouse at 2 PM on a Tuesday with forklifts running, trucks being loaded, and a shift change happening. Assess the workplace as it actually operates.
  • Include employees in the assessment. They know where the problems are. They work around hazards you have never noticed because you walk through the space differently than they do. SB 553 and Cal/OSHA's IIPP both require employee involvement — this is where it starts.
  • New assessments are required when operations change, new equipment is introduced, incidents occur, or employees report new hazards. Do not wait for the annual cycle.

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Section 2: Area Assessment Worksheets

**Complete one worksheet per area or work zone assessed.**

Area Assessment Worksheet

**Area Name:** _______________

**Area Function:** _______________

**Number of Employees in Area:** _______________

**Shifts Operating:** _______________

**Supervisor:** _______________

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2A: Physical Environment Hazards

| # | Hazard | Present? | Description | Severity | Likelihood | Risk Rating | Current Controls | Adequate? |
|---|--------|----------|-------------|----------|------------|-------------|------------------|-----------|
| 1 | **Walking/Working Surfaces** — Wet, uneven, cluttered, damaged floors; tripping hazards; elevation changes | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 2 | **Lighting** — Inadequate, excessive glare, burned-out fixtures, transition zones | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 3 | **Temperature Extremes** — Heat exposure, cold exposure, HVAC failures | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 4 | **Noise** — Levels exceeding 85 dBA, impulse noise, lack of hearing protection | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 5 | **Electrical** — Exposed wiring, overloaded circuits, damaged cords, missing covers | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 6 | **Ergonomic** — Repetitive motions, awkward postures, heavy lifting, workstation design | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 7 | **Housekeeping** — Accumulation of debris, blocked exits, improper storage | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 8 | **Exits/Egress** — Blocked, locked, inadequate signage, insufficient emergency lighting | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |

2B: Equipment and Machinery Hazards

| # | Hazard | Present? | Description | Severity | Likelihood | Risk Rating | Current Controls | Adequate? |
|---|--------|----------|-------------|----------|------------|-------------|------------------|-----------|
| 1 | **Machine Guarding** — Missing, bypassed, or inadequate guards on moving parts | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 2 | **Lockout/Tagout** — Equipment requiring LOTO procedures, adequacy of procedures | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 3 | **Powered Industrial Trucks** — Forklifts, pallet jacks, order pickers | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 4 | **Hand and Power Tools** — Condition, maintenance, appropriate use | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 5 | **Pressure Vessels** — Compressors, boilers, pressure lines | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 6 | **Vehicles** — Company vehicles, delivery trucks, maintenance status | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 7 | **Ladders/Scaffolding** — Condition, use practices, fall protection | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |

2C: Chemical and Biological Hazards

| # | Hazard | Present? | Description | Severity | Likelihood | Risk Rating | Current Controls | Adequate? |
|---|--------|----------|-------------|----------|------------|-------------|------------------|-----------|
| 1 | **Hazardous Chemicals** — Inventory, SDS availability, labeling, storage | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 2 | **Chemical Exposure** — Inhalation, skin contact, ingestion risks | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 3 | **Flammable/Combustible Materials** — Storage, quantities, proximity to ignition sources | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 4 | **Bloodborne Pathogens** — Potential for occupational exposure | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 5 | **Biological Hazards** — Mold, bacteria, vermin, infectious materials | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 6 | **Dust/Particulates** — Silica, wood dust, metal fines, general dust accumulation | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |

2D: Workplace Violence Hazards

| # | Hazard | Present? | Description | Severity | Likelihood | Risk Rating | Current Controls | Adequate? |
|---|--------|----------|-------------|----------|------------|-------------|------------------|-----------|
| 1 | **Public Access** — Unrestricted entry, no visitor management | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 2 | **Cash/Valuables** — Handling cash, drugs, or high-value items | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 3 | **Alone/Isolated Work** — Employees working alone or in remote areas | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 4 | **Client/Customer Interaction** — Volatile, emotional, or confrontational situations | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 5 | **Late Night/Early Morning** — Operations during high-risk hours | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 6 | **Domestic Violence Spillover** — Employees with known protective orders | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 7 | **Termination/Discipline** — How and where terminations are conducted | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 8 | **Security Systems** — Cameras, alarms, panic buttons, access control adequacy | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |

2E: Emergency Preparedness Hazards

| # | Hazard | Present? | Description | Severity | Likelihood | Risk Rating | Current Controls | Adequate? |
|---|--------|----------|-------------|----------|------------|-------------|------------------|-----------|
| 1 | **Fire Protection** — Extinguishers, sprinklers, alarm systems, suppression | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 2 | **Evacuation Routes** — Clearly marked, unobstructed, adequate for occupancy | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 3 | **First Aid** — Kits available, stocked, accessible, trained responders | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 4 | **Emergency Communication** — PA system, alarm audibility, notification procedures | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |
| 5 | **Natural Disaster Preparedness** — Earthquake, flood, wildfire, severe weather | [ ] Y [ ] N | | | | | | [ ] Y [ ] N |

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Section 3: Risk Rating Matrix

**Use this matrix to assign risk ratings consistently.**

Severity Scale

| Rating | Level | Definition |
|--------|-------|------------|
| 1 | **Negligible** | Minor first-aid injury, no lost time, minimal property damage |
| 2 | **Minor** | Medical treatment required, 1-3 days lost time |
| 3 | **Moderate** | Significant injury, 4-30 days lost time, moderate property damage |
| 4 | **Major** | Serious injury, hospitalization, >30 days lost time, major property damage |
| 5 | **Catastrophic** | Fatality, permanent disability, multiple serious injuries |

Likelihood Scale

| Rating | Level | Definition |
|--------|-------|------------|
| 1 | **Rare** | Could happen but never has; highly unlikely under current conditions |
| 2 | **Unlikely** | Has happened elsewhere in the industry; possible but not expected |
| 3 | **Possible** | Has happened at this workplace before or conditions make it plausible |
| 4 | **Likely** | Expected to occur; happens regularly in similar operations |
| 5 | **Almost Certain** | Will occur without intervention; has happened recently or repeatedly |

Risk Rating Calculation

**Risk Rating = Severity x Likelihood**

| | Negligible (1) | Minor (2) | Moderate (3) | Major (4) | Catastrophic (5) |
|---|---|---|---|---|---|
| **Almost Certain (5)** | 5 - Medium | 10 - High | 15 - Critical | 20 - Critical | 25 - Critical |
| **Likely (4)** | 4 - Low | 8 - Medium | 12 - High | 16 - Critical | 20 - Critical |
| **Possible (3)** | 3 - Low | 6 - Medium | 9 - High | 12 - High | 15 - Critical |
| **Unlikely (2)** | 2 - Low | 4 - Low | 6 - Medium | 8 - Medium | 10 - High |
| **Rare (1)** | 1 - Low | 2 - Low | 3 - Low | 4 - Low | 5 - Medium |

Priority Classification

| Risk Level | Score | Action Required |
|------------|-------|-----------------|
| **Critical** | 15-25 | Immediate action required. Stop work if necessary. Implement controls within 24 hours. |
| **High** | 9-14 | Action required within 7 days. Interim controls immediately. |
| **Medium** | 5-8 | Action required within 30 days. Schedule corrective action. |
| **Low** | 1-4 | Monitor. Address during routine maintenance or next scheduled improvement cycle. |

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Section 4: Corrective Action Plan

**Every hazard rated Medium or above requires a documented corrective action.**

| # | Hazard (from Section 2) | Risk Rating | Corrective Action | Control Type | Assigned To | Target Date | Resources/Budget | Status | Completion Date |
|---|------------------------|-------------|--------------------|--------------|----|-------------|------------------|--------|-----------------|
| 1 | | | | | | | | [ ] Open [ ] Complete | |
| 2 | | | | | | | | [ ] Open [ ] Complete | |
| 3 | | | | | | | | [ ] Open [ ] Complete | |
| 4 | | | | | | | | [ ] Open [ ] Complete | |
| 5 | | | | | | | | [ ] Open [ ] Complete | |
| 6 | | | | | | | | [ ] Open [ ] Complete | |
| 7 | | | | | | | | [ ] Open [ ] Complete | |
| 8 | | | | | | | | [ ] Open [ ] Complete | |

Guidance Notes

  • Corrective actions must follow the hierarchy of controls: elimination first, then engineering controls, then administrative controls, then PPE. An action plan that consists entirely of "retrain employees" and "remind supervisors" is not adequate when engineering controls are feasible.
  • Every corrective action needs one named person responsible. Not a committee. Not a department. One person with a name, a title, and a deadline.
  • Track corrective actions to completion. An open corrective action from a hazard assessment — particularly if an incident later occurs involving that exact hazard — is one of the most damaging pieces of evidence in workplace safety litigation. You identified the hazard. You documented a fix. You did not complete the fix. An employee got hurt. That sequence tells a story the jury will not like.

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Section 5: Employee Interview Summary

**Conduct interviews with at least ___ employees per area assessed.**

| # | Employee Name | Department | Date | Key Concerns Identified | Hazards Reported |
|---|---------------|------------|------|------------------------|-----------------|
| 1 | | | | | |
| 2 | | | | | |
| 3 | | | | | |
| 4 | | | | | |
| 5 | | | | | |

Interview Questions Guide

Use these questions during employee interviews:

  1. What parts of your job do you consider the most dangerous or risky?
  2. Have you experienced or witnessed any injuries or near-misses in the past year?
  3. Are there any hazards you have reported that have not been addressed?
  4. Do you feel you have adequate training for the hazards you face?
  5. Do you have the right equipment and PPE for your job?
  6. Are there any areas of the workplace where you feel unsafe?
  7. Have you ever felt threatened or intimidated at work?
  8. Is there anything about the physical workspace that makes your job harder or less safe?
  9. Do you know how to report a safety concern? Have you ever used the reporting process?
  10. Is there anything else about workplace safety you want us to know?

Guidance Notes

  • Employee interviews are not optional decoration. They are the most valuable part of the assessment. Employees see hazards every day that a walkthrough assessor will miss because the hazard only manifests under specific conditions — during a rush, during a shift change, when it rains, when that one machine runs at full speed.
  • Interview employees privately. Group settings produce conformity, not honesty. An employee who is uncomfortable saying "my supervisor ignores safety complaints" in front of their supervisor will say it in a private interview.
  • Document responses accurately. Do not sanitize or minimize what employees tell you. If three employees independently report the same hazard, that is a pattern worth highlighting.

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Section 6: Assessment Summary and Recommendations

6A: Summary Statistics

| Metric | Count |
|--------|-------|
| **Total Hazards Identified** | |
| **Critical Risk** | |
| **High Risk** | |
| **Medium Risk** | |
| **Low Risk** | |
| **Corrective Actions Required** | |
| **Corrective Actions with Immediate Deadline** | |

6B: Top Priority Hazards

List the top 5 hazards requiring immediate attention:

| Priority | Hazard | Location | Risk Rating | Corrective Action | Deadline |
|----------|--------|----------|-------------|--------------------|----|
| 1 | | | | | |
| 2 | | | | | |
| 3 | | | | | |
| 4 | | | | | |
| 5 | | | | | |

6C: Assessor Recommendations

> [Provide overall assessment findings, patterns observed, systemic issues identified, and recommendations for program improvement. This section is narrative — tell the story of what you found and what needs to change.]

6D: Next Assessment Date

| Assessment Type | Scheduled Date | Trigger Conditions |
|-----------------|----------------|-------------------|
| **Next Periodic Assessment** | | |
| **Triggered Assessment Required If** | | New operations, new equipment, incident occurs, employee complaint, regulatory change |

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Section 7: Signatures

| Role | Name | Signature | Date |
|------|------|-----------|------|
| **Assessor** | | | |
| **Facility Manager** | | | |
| **Safety Manager/WVPP Administrator** | | | |
| **Employee Representative** | | | |
| **Executive Reviewer** | | | |

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How to Use This Template

  1. **Schedule the assessment.** Notify the area supervisor and employees in advance. You want normal operations, not a cleaned-up performance.
  2. **Assemble your team.** The assessor, at least one employee from the area, and ideally the area supervisor. Different eyes see different hazards.
  3. **Walk every inch.** Do not assess from the middle of the room. Walk the perimeter. Open closets. Check behind equipment. Look up (overhead hazards). Look down (floor conditions). Check the parking lot, the loading dock, the break room, the restrooms. Hazards do not confine themselves to the production floor.
  4. **Complete Section 2 during the walkthrough.** Do not try to remember hazards and document them later. Document in real time.
  5. **Conduct employee interviews separately.** After or independently from the walkthrough.
  6. **Rate every identified hazard.** Use the risk matrix in Section 3. Be honest about severity and likelihood. Underrating hazards to avoid corrective action obligations is a short-term convenience that creates long-term liability.
  7. **Develop corrective actions for every Medium-and-above hazard.** Assign owners and deadlines. Enter them into your tracking system.
  8. **Present findings to management.** The assessment is useless if it sits in a file. Management must see the results, approve the corrective actions, and allocate the resources to complete them.
  9. **File the completed assessment** in your IIPP documentation and cross-reference in your WVPP if workplace violence hazards were identified.

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*Protekon conducts comprehensive hazard assessments as part of every managed compliance engagement. Our assessors know what Cal/OSHA inspectors look for because we have seen the citations that result from assessments done poorly. We identify the hazards, rate the risks, build the corrective action plans, and track them to completion. Your job is to run your business. Our job is to make sure the hazards are found before the inspector — or the injury — finds them first.*