Site Safety Assessment Guide

Online SSA Form

Please Note: You can complete this form with or without Internet connection. If offline, please leave the completed form open in your browser. After connecting to the Internet, you can the click the Download as PDF button to generate your PDF document.
SSA Form



Risk Classifications
Low (Green)
Moderate (Yellow)
High (Red)
Please see guide to SSA "Risk Matrix"
Controls Required
Boxes should be filled in first by RISK CLASSIFICATION and then CONTROL NUMBER(S) Example: M 2

Complete new form as conditions change. Be alert to hazards not mentioned below. Please see guide to SSA.
Slip / Trip / Fall Hazard
  • Holes in floor
    Railing missing
    Working above 10'
  • Work above 25'
  • Poor lighting
    Site cluttered
    Loose step covering
  • Ice / Snow
    Slippery surfaces
    Watch your step...
Physical Hazard
  • Structure unsafe
    Floor unsafe
    Ceiling unsafe
    Falling object
  • Flying debris
    Sharp objects
    Power tools
  • Razor knife
    Forceful push / pulling
    Awkward lifting
    Heavy lifting
  • Animal related
    Extreme heat / cold
    Take care when lifting...
Mechanical Hazard
  • Crushing / cutting
    Crushing / falling
    Falling objects
  • Mobile Equipment
    Pressure lines
    Underground / excavation / wells
  • Exposed moving parts
  • Pilot lights
    Furnace backdraft
    Lock out / Tag out required?
Electrical Hazard
  • Exposed electrical panels
    Underground wires / conduits
    Energized equipment
  • Exposed / bare wires
    Water / wet areas
  • Overhead wires
    Concealed wires
    Lock out / Tag out required?
Chemical Hazard
  • Flammables
    Natural gas / oil
  • Cleaning products
    Smoke / fume
    Volatile organic compounds (VOCs)
  • Hazardous gases
    Hazardous Atmosphere
  • Unidentified chemicals
    Spontaneous combustion
    Safety Data Sheet Available?
Hazardous Materials
  • Asbestos
  • Mould / Fungi
    Animal droppings
    Bodily fluids
  • PCB's
    Radioactive materials
  • Haz Mat Survey Conducted?
    Yes No
    Pending Posted
Confined Space Hazard
Confined Space Entry: If you answer "yes" to all 4 questions then a specific work and rescue procedure may be required. If you are unsure of the answer, contact your supervisor. Only suitably trained workers may enter a Confined Space.

  • Yes No Does the space have limited or restricted means for entry or exit that may complicate emergency response service?
    Yes No Is the space enclosed or partially enclosed?
    Yes No Is the space large enough and configured in such a way that a person could enter to perform work?
    Yes No Is the space not designed or not intended for continuous human occupancy?
Check Box Of Required Personal Protective Equipment On This Site

Are other site specific Notices / Permits / Plans required (including Working Alone)? Use notes at bottom   Yes No
Site Safety Assessment Meeting - Safety Hazard Discussion (ENTER NAMES OF ATTENDEES)

  • Identify hazards on a job site
  • Assign risk level for each identified hazard
  • Define controls for identified hazards
  • Assign responsibility to implement controls
  • Communicate the hazards to workers
  • Document the process
  • Completion of an SSA is required on any jobsite before work begins
  • Updating the SSA is required as conditions change on the job site
  • Completion of a new SSA is required at the start of a new shift
Worker Responsibility
  • Complete an SSA before beginning work
  • Involve coworkers in the SSA process
  • Update the SSA as conditions change
  • Post a copy of the SSA at the entrance to the work area
Supervisor Responsibility
  • Ensure an SSA has been completed and posted
  • Ensure the SSA has been completed properly
  • Ensure any assigned actions to implement controls have been assigned and completed
  • Communicate any updates to workers