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69 <br /> <br /> (√) <br />If Present Potential Hazard Potential Harm <br /> Source And Location Of Hazard <br />(identify hazard) <br /> <br /> PHYSICAL HAZARDS <br /> Wet, slippery or cluttered floors, stairs, <br />or landings <br />May cause worker to slip, trip, or fall. May result <br />in injury or death. <br /> Floor openings or holes May cause worker to slip, trip, or fall. May result <br />in injury or death. <br /> Unguarded platforms Worker may fall. May result in injury or death. <br /> Rotating or moving machinery Worker may become caught between moving <br />parts. May result in injury or death. <br /> Hand and power tools Use may cause lacerations, abrasions, <br />fractures, amputations, and/or electrocutions. <br />May result in injury or death. <br /> <br /> Abrasive grinders Use results in flying particles. Wheel may <br />explode. May cause face/eye injuries. <br /> Compressed air for cleaning Use may result in flying particles. May cause <br />face/eye injuries. <br /> Pressure vessels - air, steam, water, <br />or gas <br />Mechanical explosion. May result in injury or <br />death. <br /> Fixed electrical equipment Electrocution and/or fire. May result in injury or <br />death. <br /> Portable electrical equipment and <br />extension cords <br />Electrocution and/or fire. May result in injury or <br />death. <br /> Head hazards (e.g. falling <br />objects/bumps to head) <br />Worker could be struck. May result in injury or <br />death. <br /> Eye/face hazards (e.g. flying particles, <br />harmful light and chemicals) <br />May cause blindness or injuries to face (e.g. <br />cuts, thermal burns, and chemical <br />exposure/burns). May result in injury or death. <br /> <br /> Hand hazards (e.g. sharp objects, <br />heat/fire, and chemicals) <br />May cause lacerations, abrasions, thermal <br />burns, and chemical burns/exposure. May result <br />in 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 /> <br />