The Health Hazard Evaluation Form is a crucial document required under Belgian workplace safety legislation, specifically designed to comply with the Belgian Well-being at Work Code and related EU directives. This form should be used whenever there is a need to assess potential health risks in the workplace, whether for routine evaluations, after significant changes in work processes, or in response to health concerns. The document encompasses comprehensive evaluation of workplace conditions, including detailed assessment of physical, chemical, biological, and ergonomic hazards, exposure levels, and existing control measures. It serves as both a legal record and a practical tool for implementing workplace safety improvements, requiring input from relevant stakeholders including health and safety professionals, management, and worker representatives.
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1. 1. Administrative Information: Basic details including date, location, evaluator information, and department/area being evaluated
2. 2. Workplace Identification: Specific details about the workplace or area being assessed, including address, department, and work processes involved
3. 3. Description of Operations: Detailed description of work activities, processes, and equipment used in the area being evaluated
4. 4. Hazard Identification: Systematic listing of potential health hazards identified in the workplace, including physical, chemical, biological, and ergonomic hazards
5. 5. Exposure Assessment: Evaluation of exposure levels, duration, and frequency for each identified hazard
6. 6. Control Measures: Current control measures in place and their effectiveness
7. 7. Risk Classification: Assessment of risk levels based on probability and severity of potential health effects
8. 8. Recommendations: Specific measures recommended to eliminate or reduce identified health hazards
9. 9. Action Plan: Timeline and responsibilities for implementing recommended control measures
10. 10. Review and Signatures: Validation section for relevant parties including evaluator, employer representative, and worker representative
1. Medical Surveillance Requirements: Details of required medical monitoring programs - include when specific hazards require medical surveillance under Belgian law
2. Emergency Response Procedures: Specific emergency protocols - include when dealing with high-risk hazards that could require immediate response
3. Worker Consultation Record: Documentation of worker input and concerns - include when worker consultation has been part of the evaluation process
4. Historical Incident Analysis: Review of past incidents or near-misses - include when there is relevant historical data
5. Economic Impact Assessment: Cost analysis of hazards and controls - include when financial justification for controls is needed
1. Appendix A: Measurement Data: Detailed results of any workplace measurements or monitoring (noise levels, air sampling, etc.)
2. Appendix B: Risk Assessment Matrix: Standardized risk assessment criteria and scoring system used
3. Appendix C: Photos and Diagrams: Visual documentation of workplace conditions and hazards
4. Appendix D: Technical Data Sheets: Safety data sheets for chemicals and technical specifications for equipment
5. Appendix E: Regulatory References: Relevant Belgian and EU standards and exposure limits referenced in the evaluation
6. Appendix F: Monitoring Schedule: Timeline for ongoing monitoring and review of identified hazards
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