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67 <br /> <br />City of Mounds View <br />FORM SP-1 HAZARD INVENTORY <br /> <br />Check (√) those hazards that are present or likely to be present in the work place. Identify source and location of each hazard that is present or likely to be present in the workplace. Evaluate and provide <br />for control of all hazards identified in accordance with applicable regulations. Provide for employee information and training on all hazards identified in accordance with applicable regulations. <br /> Facility: Area/Operation: <br /> <br />Affected Positions: Compiled By: Date: <br /> <br /> (√) <br />If Present Potential Hazard Potential Harm <br /> Source And Location Of Hazard <br />(identify hazard) <br /> <br /> ENVIRONMENTAL HAZARDS <br /> Noise May cause stress, fatigue, and/or loss of <br />hearing. May interfere with communication, and <br />thereby contribute to accidents/injuries. <br /> <br /> Air contaminants May cause illness, injury, and/or death. <br /> Hot environments May cause heat cramps, heat exhaustion, <br />and/or heat stroke. Serious cases may cause <br />delayed injury or death. <br /> <br /> Cold environments May cause frostbite and/or hypothermia. <br /> Wet environments May cause illness or worker to slip, trip, or fall. <br />May result in injury or death. <br /> Confined spaces May contain atmospheric, entrapment, <br />engulfment, and/or other serious hazards. May <br />result in injury or death. <br /> <br /> Lighting May interfere with worker’s ability to recognize <br />job site safety and health hazards. May result in <br />injury or death. <br /> <br /> Biological organisms or agents May cause disease. May cause illness or <br />death. <br /> Microwave and other non-ionizing <br />radiation <br />May cause thermal burns and heat build up in <br />body tissues or other bodily injury. May result in <br />injury or death. <br /> <br />This checklist provides general guidance for the identification of common work place hazards. It is not all-inclusive. The employer must customize the form for the specific work place. <br /> <br />