First Aid Hazard Assessment Form

Here is a First Aid Hazard Assessment Form designed for OHS managers. It aligns with the highest regulatory standards and is generic enough to be applicable across industries.

 

Company Name:
Location:
Date of Assessment:
Assessor’s Name:
Job Title:

  1. WORKPLACE DETAILS

Industry Type:

Number of Employees:

Work Shifts:
☐ Day ☐ Night ☐ Rotating

Workplace Layout:
☐ Office ☐ Manufacturing ☐ Warehouse ☐ Construction ☐ Other:

  1. HAZARD IDENTIFICATION
  2. Physical Hazards (Check all that apply)

☐ Slips, Trips, and Falls
☐ Falling Objects
☐ Working at Heights
☐ Extreme Temperatures (Hot/Cold)
☐ Confined Spaces
☐ Machinery & Equipment Hazards
☐ Fire/Explosion Risks
☐ Electrical Hazards
☐ Other: ___________________________

  1. Chemical Hazards

☐ Exposure to Hazardous Chemicals
☐ Toxic Gas/Vapors
☐ Flammable Substances
☐ Corrosive Materials
☐ Other: ___________________________

  1. Biological Hazards

☐ Bloodborne Pathogens
☐ Infectious Diseases
☐ Mold/Fungi
☐ Animal/Insect Exposure
☐ Other: ___________________________

  1. Ergonomic & Work-Related Stress

☐ Heavy Lifting
☐ Repetitive Movements
☐ Extended Standing/Sitting
☐ Mental Stress/Workload Pressure
☐ Other: ___________________________ 

  1. INJURY/INCIDENT HISTORY

Have first aid incidents occurred in the past 12 months?
☐ Yes ☐ No

If yes, specify types of injuries and their frequency: