1EnvironmentalHealthandSafety|2408WandaDaleyDrive|Ames,IA50011-3602|Ph:(515)294-5359|www.ehs.iastate.eduReviewed2017WorkplaceHazardAssessmentforPersonnelwithAnimalContactInstructions:Completethistableforthehazardsyoumayencounterwhiledoingyourassignedduties,andincludestrategiestomitigatethosehazards.Pagethreeandfourcanbeusedasaguide.Multipleformsmaybeused,asneeded,toincludeallworkareasandjobfunctionswithinthedepartment.ThisformwillhelpyoucompleteyourStandardOperatingProcedures(SOP).Department:WorkLocation(s):Colleges:JobTitles:HazardsPresentCheckAllThatApplyDescriptionofHazard(Whatwillyoubedoing?)HazardMitigationStrategiesPPETrainingOtherControls1.Allergens,dust2.Biologicallyinfectiousmaterials3.Bites/Scratches4.Chemicals5.Compressedgases6.Crush,Kicks,Stepon7.Electricity2EnvironmentalHealthandSafety|2408WandaDaleyDrive|Ames,IA50011-3602|Ph:(515)294-5359|www.ehs.iastate.eduReviewed2017HazardsPresentCheckAllThatApplyDescriptionofHazard(Whatwillyoubedoing?)HazardMitigationStrategiesPPETrainingOtherControls8.Ergonomichazard9.Heat10.Horns/Goring11.Machinery12.Noise13.Radiation,UV,Lasers14.Sharps,needlesticks15.Zoonoticagents16.MiscellaneousAssessmentCompletedby:___________________________Signature:_______________________________Date:__________________AllpersonnelhavingcontactwithanimalsmustcompleteaHazardInventoryforOccupationalExposureform.3EnvironmentalHealthandSafety|2408WandaDaleyDrive|Ames,IA50011-3602|Ph:(515)294-5359|www.ehs.iastate.eduReviewed2017Checkanyofthequestionsthatapplytothedutiesthatyouwillbeperformingwhiledoingyourjob.AThenumbersinthiscolumn,correspondtothehazardslistedinthe“HazardsTable”onpage4HazardAssessmentQuestionnaireCheckallthatapplyQuestionsHazardstoConsiderADoyouhavecontactwithanyofthefollowinganimals:Chickensorotherpoultry?1,12,15Catsordogs?1,3,12,15Exoticsorwildlife?1,3,12,15Insects?1,3Largelivestock(horses,cattle)?1,6,8,10,15Mice,ratsorotherrodents?1,3,15Pigs?3,8,12,15Sheep/goats?1,8,10,15Doyouworkwithanimalsinaconfinementenvironment?1,9Doyouworkwithanimalsinthewild?3,15Doyoudogeneralhusbandryforanimals(feeding,cleaning,etc)?1,8,Doyouchangebeddingofanimals?1,3,8Doyoumoveortransportanimals?8,11Doyoudoroutinemedicalcareonanimals(inoculation,drawingblood,administeringmedication)?4,14Doyouperformsurgeriesorstandincloseproximitywhilesurgeriesareoccurring?5,14Doyouperformeuthanasiausinganyofthefollowingmeans:Inhalantagents(carbondioxideormonoxide,nitrogen)5Noninhalantchemicalagents4Cervicaldislocation3Decapitation3,11Electrocution7PenetratingcaptiveboltorGunshot8Doyouperformnecropsiesonanimals?8,11,14Doyouliftormovethingsweighingover50lbs?8Doyouperformrepetitivetasks?8Doyouworkaroundmachinery(tractors,cagewasher,etc)11,12Doyouworkinareaswithlowlightornolight?8Doyouworkinareasthatareextremelyhotorextremelycold?9Doyouusesharps(needles,knives,etc)?14Doyouworkinareaswherethereisahighlikelihoodofslipsortrips?8Doyouworkwithinfectiousbiologicalagents?2Doyouworkwithorareyoupotentiallyexposedtohumanbloodormammaliancells?2Doyouworkwithchemicals?4DoyouworkwithradiationorradiationproducingdevicessuchaslasersorUV?134EnvironmentalHealthandSafety|2408WandaDaleyDrive|Ames,IA50011-3602|Ph:(515)294-5359|www.ehs.iastate.eduReviewed2017Thistablecontainscommonhazardsyoumayencounterwhileperformingyourjobduties.TheMitigationStrategiescanbeusedtocomplete“YourHazardsTable”...