Syracuse University Multi-Employer Workplace Program

Hazard Assessment Form

It is the responsibility of the senior occupant for the area where work will be performed to ensure that a Hazard Assessment is conducted prior to the start of the project. It is also the responsibility of the senior occupant to ensure that hazardous materials are removed from the work area, whenever feasible. For any hazardous materials which must remain in the area, a Hazard Identification Form must be completed and must include the precautionary measures which will be taken to limit potential exposures.

Follow the steps below to complete a Hazard Assessment of your area. If hazardous materials must remain in the area, you also complete the Hazard Identification Form.

STEP 1. Locate the Hazard Communication Program Material Safety Data Sheet (MSDS) Binder for the area.

STEP 2. Review the index of hazardous materials for the area.

STEP 3. Identify, remove and relocate, as feasible, any hazardous materials which could potentially result in exposure.

STEP 4. Ensure that all remaining hazardous materials are properly labeled and stored and complete the Hazard Identification Form for these materials.

STEP 5. Amend the index of hazardous materials to reflect the hazardous materials that were removed fromt he area. Additionally, compile a new index for the materials removed to reflect their new location. Notify EHO of all changes in binder information.

STEP 6. Inform the procuring department (using the Hazard Identification Form) of the precautionary measures which must be taken to ensure that exposures to hazardous materials are controlled as recommended/required by the material's MSDS.

STEP 7. Read, sign and return this form to the Syracuse University procuring department (i.e. Office of Design and Construction).

As the senior occupant responsible for the area listed below, I certify that an assessment of the area was conducted and that precautionary measures (as recommended/required by the material's MSDS) which must be taken to limit potential exposures resulting from hazardous materials remaining in the area are listed on the Hazard Identification Form.

Signed:____________________________

Title:___________________________________

Work Area Location:__________________Date:________________

Person who performed Hazard Assessment if different from above:

Name: ___________________________________

Title:____________________________________