Equipment Hazard Analysis Form
Facility:
BG-A
BG-N
BG-R
BG-W
Franklin
Waukegan
Approved:
Yes
No
Conducted By:
Date Conducted:
Approved By:
Review Date:
Equipment Item:
Equipment Type:
Make/Model No.:
Work Location:
Description of Use:
Summary of Key Risks:
User Certification Required:
Yes
No
Operator Manuals Accessible:
Restricted Use:
PPE Eye Protection:
PPE Face Shield:
PPE Safety Footwear:
PPE Protective Clothing:
PPE Hearing Protection:
PPE Gloves:
PPE Respiratory Protection:
Decibels:
Routine Operation Hazards:
Routine Maintenance Hazards:
Shutdown and Isolate Unit Hazards:
Preventive Measures:
Equipment Procedures:
Attach Image/Video Files:
Submit
