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72 <br /> <br /> <br /> (√) <br />If Present Potential Hazard Potential Harm <br /> Source And Location Of Hazard <br />(identify hazard) <br /> <br /> WORK RELATED HAZARDS <br /> Employees handle/use hazardous <br />chemicals <br />May cause illness, injury, or death. <br /> Employees remove or encapsulate <br />asbestos <br />Asbestos is known to cause asbestosis, lung <br />cancer, and mesothelioma. May result in illness <br />and death. <br /> <br /> Employees sand, grind, cut, or weld <br />on lead containing materials <br />Lead is known to cause acute or chronic lead <br />poisoning and/or injury to repr oductive system. <br />May result in illness and death. <br /> <br /> Employees service or perform <br />maintenance on equipment/machines <br />Worker may become caught between moving <br />parts. May result in injury or death. <br /> Employees perform maintenance on <br />electrical equipment <br />Electrocution. May result in injury or death. <br /> Employees enter permit confined <br />spaces <br />May contain atmospheric, entrapment, <br />engulfment and/or other serious hazards May <br />result in injury or death. <br /> <br /> Employees perform work from <br />unguarded elevated surfaces <br />Worker may fall. May result in injury or death. <br /> Employees perform work in <br />excavations and trenches <br />Trench may cave-in. May result in injury or <br />death. <br /> Employees perform work on <br />streets/roads <br />Worker may be struck by a vehicle. May result <br />in injury or death. <br /> Employees perform work in close <br />proximity to heavy equipment <br />Worker may be struck by a vehicle. May result <br />in injury or death. <br /> Employees operate heavy equipment <br />(e.g. end loaders, trucks, etc.) <br />Vehicular accidents. May result in injury or <br />death. <br /> Employees operate forklifts Vehicular accidents. May result in injury or <br />death. <br /> Employees operate aerial lift trucks Boom could contact power line. Employee could <br />fall. May result in injury or death. <br /> <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 />