Division of Occupational Safety & Health MS: 44600
Date/Time WAC #
Classifi. Citation # Item # Grp Inst Inspection Report #
HAZARD DOCUMENTATION WORKSHEET (1 C)
Abatement Period
/ / Description of observed hazards, conditions and practices
Measurements Method of measurement (tape measure, blueprints, employer statement, other)
Exposed employee Address
Occupation Phone number
# EEs exposed
Duration of hazard
Frequency of exposure
Equipment Type SN
Make HP RPMs
Model Voltage Amperage
Comments (Employee statement. Employer statement. How complied. PPE, guards, controls)
Abatement method to comply Discussed with employer regarding abatement assistance.
F418-031-000 hazard documentation worksheet - 1 c 1-07
(Grid on back side of paper)
F418-031-000 grid