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Division of Labor Standards
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Managing Worker Safety and Health

APPENDIX 7-3

PROCESS HAZARD ANALYSIS WORKSHEET

1. Name the process.
 
2. Give the date the operations began.
 
3. Write a short description of the process.
 
 
 
4. Conduct an overview and write a narrative.  (See Appendix 7-1).  Date completed?
 
 
 
5. Prepare process flow chart and attach.  (See sample, Appendix 7-2).  Date completed?
 
6. For each step in the process as shown on your flow chart, identify and record each:
a.  hazardous substance,
 
b.  piece of equipment that presents a hazard, and;
 
c. employee operation that may be hazardous.