17 - Manual Handling Operations Record

• Site conducted

  Select
• Location
  Address

• Conducted on

  Date

• Prepared by

• Activity?

• Materials to be Handled?

• Hazardous Contents?

  Yes

  No

• Can Manual Handling Be Eliminated?

  Yes

  No

Task

• 

• Carring

  Yes

  No

• 

• Stooping

  Yes

  No

• 

• Repetition

  Yes

  No

• 

• Twisting

  Yes

  No

• 

• Pushing

  Yes

  No

• 

• Pulling

  Yes

  No

• 

• Lifting High

  Yes

  No

• 

• Lifting Low

  Yes

  No

• 

• Reaching high

  Yes

  No

• 

• Reaching Low

  Yes

  No

• 

• Handling While Seated

  Yes

  No

• 

• Bending Sideways

  Yes

  No

Person

• 

• Need for Unusual Strength or Height

  Yes

  No

• 

• Training Required?

  Yes

  No

• 

• PPE to be Worn

  Yes

  No

• 

• 18 - 55 Years?

  Yes

  No

• 

• Medical Condition or History

  Yes

  No

Load

• 

• Bulky / Un-Wieldly

  Yes

  No

• 

• Difficult To Grip

  Yes

  No

• 

• Hot

  Yes

  No

• 

• Cold

  Yes

  No

• 

• Heavy

  Yes

  No

• 

• Light

  Yes

  No

• 

• Abrasive / Sharp

  Yes

  No

• 

• Eccentric Shape

  Yes

  No

• 

• Unstable

  Yes

  No

Environment

• 

• Hot

  Yes

  No

• 

• Cold

  Yes

  No

• 

• Dusty

  Yes

  No

• 

• Noisy

  Yes

  No

• 

• Windy

  Yes

  No

• 

• Humid

  Yes

  No

• 

• Vibration

  Yes

  No

• 

• Confined Space

  Yes

  No

• 

• Steps

  Yes

  No

• 

• Slopes

  Yes

  No

• 

• Uneven Surfaces

  Yes

  No

• 

• Obstructions

  Yes

  No

• Over all Risk Factor:

  High

  Medium

  Low

• Control Measures:

• Signature:

  Sign