1A24

• Project Area

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

Work activity

• Advise the work activity that appears to be a risk

• Enter details of activity

Identified hazards

• Do you feel there are safety concerns with the temperature on site (Hot/ Cold)?

  High

  Medium

  Low

• Do you feel the noise levels are acceptable?

  Yes

  No

  N/A

• Do you have adequate hearing protection?

  Yes

  No

  N/A

• Are you aware of the location of the/ a first aid kit(s)?

• Do you feel that all other people on site are acting in a safe manner?

  Yes

  No

  N/A

• Do you feel all equipment/ tools are in good, safe working order?

  Yes

  No

  N/A

• Do you feel you have all required PPE for today's work?

  Good

  Fair

  Poor

  N/A

• Is there adequate fire protection for all equipment?

  Yes

  No

  N/A

• Are you aware of the fire extinguisher(s) location(s)?

  Yes

  No

  N/A

• If there is any equipment operation required, are you comfortable and trained to work around such equipment?

  Yes

  No

  N/A

• Are there any electrical hazards?

  Yes

  No

  N/A

• Is the general housekeeping safe? Trips, slips and fall hazard?

  Yes

  No

  N/A

• Can you alone make this safe?

  Yes

  No

  N/A

• Can you notify a manager to alert of the safety concern?

• How many hazards identified in relation to the particular activity

• Take picture of hazard if possible

  Media

Who might be harmed?

• Who can be harmed or affected by these risks?

  Staff

  Client/Visitors

  Everyone

Description

• Advise description of risks

Risk rating

• Severity

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Probability of occurance

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Resolution

• Indicate if this risk can be controlled immediately or not

  Select Requires Additional attention / control Adequately Controlled Unknown Risk

  • Requires Additional attention / control
  • Adequately Controlled
  • Unknown Risk

Implement plan

• Enter description of implementation plan

• List who will be responsible for actioning the implementation plan

• When will this be actioned and completed by?

  Date

Completion

• Risk assessment has been completed

  Yes

  No

  N/A

• Risks reported have been resolved and completed

  Yes

  No

  N/A

• Signature

  Sign