Date: [//_____]
Project/Job Site: _____________________________________
Supervisor: ___________________________________________
Name of Assessor: _____________________________________
Role/Position: ________________________________________
Description of Task:
Planned Duration of Task: ______________________________
Equipment/Tools Used:
Potential Hazard | Risk Level (Low/Medium/High) | Control Measures | Person Responsible |
---|---|---|---|
(Add more rows as needed) |
Weather Conditions: ___________________________________