TITLE:	ES&H Manual
DOCUMENT ID:	3210 Appendix T2 Hazard Identification Worksheet

Task Title:	Name:		Date:
Location:		Co-Workers:
Instructions: Answer the following questions. Answers that indicate a pre-mitigated hazard may exist should be discussed with your supervisor/manager/ESH&Q staff. Resolution and hazard mitigation must be noted in the block provided.

General Conditions	Keywords	Y/N	Resolution
1. Are you familiar with the MSDS requirements for the materials being used and the required Personal Protective Equipment (PPE)?	acids, flammable gases and solvents, heavy metals (lead, etc.), respirator, gloves, aprons, face shield, safety glasses, working with flammables
2. Will you create dust, welding arcs, heat, excessive noise, ionizing/non-ionizing radiation, or chemical mixtures during the tasks?	welding grinding, painting, x-rays, respirator, gloves, RF, lasers, chemicals, epoxies
3. Are there any fire or explosive hazards associated with the task or likely to develop because of the task?	painting, welding, grinding, brazing, mixing chemicals, battery charging
4. Could the task create headaches, breathing problems, or dizziness from odors, etc.?	motor exhaust, painting, ozone, solvents, acids, bases, chemicals, portable heaters
5. Is the task performed where there is limited space? Does this create additional hazards? Do other conditions such as limited entry, egress, or poor ventilation exist?	restricted workspace or inadequate work surfaces, confined space, manholes, pits, tanks
6. Does the task require compressed, liquefied, or noxious gases?	cryogenics, nitrogen, helium, argon, carbon monoxide
7. Does the task require work in areas or with materials subject to temperature extremes?	welding, soldering, brazing, cryogenics, resistive heating
8. Does the task involve the use of fork trucks, hoists, or cranes?	manlifts, subcontractors, rentals, slings, rigging
9. Does the task involve the use of powered hand tools or the use of sharp instruments?	drills, saws, PPE, GFCI, power activated tools, box cutters, wire strippers, or devices using X-acto blades
10. Does the work involve the risk of electrical shock or other forms of hazardous energy?	LOTO, compressed gases, lasers, power supplies, pressure, cryogenics
11. Does the task involve working above or below floor level?	ladders, scaffolds, ODH, fall protection, confined space
12. Does the task involve lifting, pulling, pushing, or carrying heavy objects, or repetitive motion?	posture, back injury, twisting, fork lifts, cranes
13. Does the task involve work with pressurized or vacuum vessels?	GFCI resistive heaters, pressure relief, tanks, containers
14. Does the task require any permits?	RWP, FHWP, confined space, Energized Electrical Work Permit, Dig or Blind Penetration Permit
15. Does the task require specialized training?	subcontractors, scaffold, manlift, confined space
16. Will waste products require special handling or disposal requirements?	chemicals, by products, discharges to sewer or ground, HRSD
17. Does the task involve the handling of materials with sharp edges?	unguarded sharp metal edges from machining, cutting, drilling, welding
18. Do constraints on space make this task more difficult (work environment)?	confined space, restricted workspace
19. Any other hazards we may have overlooked with this list?

This worksheet is intended as just a starting point. Having identified the hazards associated with this task, next review the associated guidance in the ESH&Q Manual and develop procedures and controls tailored to the work.

ISSUING AUTHORITY

APPENDIX AUTHOR

APPROVAL DATE

EFFECTIVE DATE

EXPIRATION DATE