APPENDIX 1
HAZARD IDENTIFICATION FORM

Hazard Identification Form in PDF format
Hazard Identification Form in MS Word format

(to be filled out by trip leader and filed with LOC Safety Officer or
Appropriate Section/Division Head or designate prior to trip departure )

Example of a completed Hazard Identification Form


Field Trip Name          _________________________________________________

Date                           _________________________________________________

Field Trip Leader       _________________________________________________

Responsible Safety officer      ____________________________________________

General Hazards
 
 

  Nature of Hazard   Location of Hazard  Mitigation
 
 
 
 
   

 
 
 
   

STOP _________
 

Nature of Hazard   Location of Hazard  Instructions to participants
 
 
 
 
   
 
 

 

 

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   

STOP _________
 

  Nature of Hazard  Location of Hazard Mitigation

 
 
 
   

 
 
 
   
Last modified: May 2, 2010
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