| A | B | C | D | E | F | G | H | I | |
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1 | Date: | Student Hazard Assessment Template | |||||||
2 | Completed By: | NOTE: To get an editable version of this document please go to File > Make a Copy or File > Download > Excel | This hazard assessment template is to be completed prior to undertaking any at-home lab exercise or experiment | ||||||
3 | Task/Step | Hazard | Existing Controls or Controls Needed | Post-Control Risk Rating | |||||
4 | Low/Medium/High | ||||||||
5 | Example: Work Outdoors | Example: Slips/Trips/Falls (Ice in Winter, Uneven Ground in Summer) | Example: Proper footwear, Scheduling/Planning, Shovelling/Removing Ice on your property | Medium | |||||
6 | Example: Heat Stress during the summer | Example: Wear light clothing, Stay Hydrated, Take Breaks, Choose Shaded Areas | Low | ||||||
7 | Example: UV Exposure from the Sun | Example: Wear long sleeves, pants, and a wide brimmed hat or wear sunscreen, Choose shaded areas, Avoid highest UV hours of 10AM to 3PM | Medium | ||||||
8 | Example: Mosquitos, Ticks, and other Bugs | Example: Wear long sleeves/pants, Wear Bug Spray, Avoid dusk/dawn for mosquitos, Avoid nests, hives, or shrubbery | Low | ||||||
9 | Example: Cold Stress during the winter | Example: Wear appropriate winter clothing, take breaks in a warm environment, choose areas shielded from the wind | Low | ||||||
10 | Example: Work on a Computer | Example: Ergonomics - Static Posture | Example: Set up work station properly, take breaks | Low | |||||
11 | Example: Ergonomics - Repetitive Motion | Example: Set up work station properly, take breaks | Low | ||||||
12 | Example: Eye Strain | Example: 20/20/20 Rule (Every 20 minutes, look at something ~20 feet away for 20 seconds) | Low | ||||||
13 | Example: Psychosocial Concerns | Example: Violence/Harassment In Public | Example: Plan to stop work and leave the area if needed. Let someone know your location and expected time of return. Plan activities during daylight hours. | Low | |||||
14 | Example: Mental Health Stress from Isolation | Example: Take advantage of online resources, stay in contact with fellow classmates/instructor, and friends and family | Medium | ||||||
15 | Example: COVID-19 Pandemic | Example: COVID-19 | Example: Physical distancing, wear a mask in public indoor areas, Hand hygiene, Other public health measures | Low | |||||
16 | Example: Task Specific | Example: Stove/Cooking Utensils - Flammable/Burns | Example: Use in a well-ventilated area, Remove all flames/sparks, wear PPE | Low | |||||
17 | Example: Use of Tools (Cuts) | Example: Ensure all guards are in place, follow procedures, training on proper use of tools | Low | ||||||
18 | Example: Use of Tools (Electricity) | Example: Ensure power cords are in good condition, remove sources of water or use GFCI | Low | ||||||
19 | Example: Chemical Hazards to Health or the Environment | Example: Only consumer products used, no hazardous materials should be included for use at home | Low | ||||||
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23 | Pre-Assignment Checklist | ||||||||
24 | Instructions have been read and understood | Departure/Arrival times are confirmed | |||||||
25 | Lab-related materials are available | Route is planned/Work Areas are designated | |||||||
26 | Tools and other equipment are available | Emergency plan is understood (response to: change in weather, change in conditions, injury/illness) | |||||||
27 | PPE is readily available | Check-ins are scheduled with a friend or family member | |||||||
28 | PPE requirements are understood | ||||||||
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