Workplace Hazard Analysis - Real Estate Personnel

OSHA requires that we are aware of, prepare for, and train our temporary employees regarding any potential hazardous / dangers at the workplace. This information will allow us to help prepare our temporary employees working at your site to safely complete the responsibilities of the assignment. We are honored to be your staffing partner.

Property Name:

Property Address

Name of individual completing this form

Title

Date

Please review the following 12 questions, and electronically sign.

1.) Please check the safety training your company provides our temporary employees and provide any comments you may have:

Location of fire extinguishers
Location of first aid supplies
Contact phone numbers of emergency personnel
Location of emergency exits
Location and use of safety equipment
Procedures for safely dealing with irate tenants
Procedures for safely showing apartment
Other training provided not covered by the above

Comments

2.) Please check any chemicals our temporary employees may be exposed to and any related comments:

Comments

3.) Please check any high pressure equipment temporary employees may be exposed to and any related comments:

Boilers
Compressed Gas
Air compressors

Comments

4.) Please check any electric shock exposure our temporary employees may be exposed to and any related comments:

Metal ladders near power lines
Use of electrical hand tools
Installation/replacement of appliances
Light fixture replacement
Installation/replacement of light switches or plugs
Fuse box (replacement of fuses or box installation and repair)
Ballast replacement conduit repair or replacement

Comments

5.) Please indicate the amount of weight our temporary employees may need to lift relative to the listed items and any related comments:

Comments

6.) Please check any exposure to slip and falls our temporary employees may be exposed to and any related comments:

Comments

7.) Please describe any ladders our temporary employees may be exposed to:

Type(folding, extension, step, etc…)

Rating(household, commercial, industrial, heavy duty)

Ladder height

Ladder condition

Do you supply fall arrest safety harnesses?

Comments

8.) Please check any equipment are temporary employees may be exposed to and any related comments:

Comments

9.) Please inform us of any crime in the last 12 months associated with your location by indicating the number of incidences:

Known gang activity

Assault

Drug related

Auto burglary

Theft

Residential burglary

Murder

Comments

10.) Please check if you have known issues with the following that our temporary employees may be exposed to and any related comments:

Comments

11.) Will our employee be asked to remove:

Wasp / Bee nests or hives
Varmints such as squirrels, raccoons, etc…

12.) Lead Issues: Was your property built before 1978?

Yes
No

If so has the property been lead free certified?

If so do you have a lead free certified manager on site?

I attest that the information I have provided is complete and accurate to the best of my knowledge.

Name *

Date *

Signature