ABCo Job Hazard/Risk Assessment Method Statement

• Job Hazard/Risk Assessment [number] [first] [last]

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Information

• Risk Rating Guide

  

• Either "YES" or "NO" MUST be ticked for EVERY choice in the Hazard identification section. Where a hazard exists, sufficent control measures must be implemented and a Risk Assessment or Safe Work Procedure must be referenced.
  
  IF WORK CONDITIONS CHANGE, TASKS MUST BE RE-ASSESSED

• Title and description of the task being assessed

• Broadspan Photo of Area

  Media

Hazards

• Electrical - Overhead or Underground

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Telephone or other cables

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Pipelines - Gas, Sewer, Storm Water

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Vehicles, Pedestrians, General Public

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Moving Machinery / Vehicles

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Weather Conditions

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Uneven, Slippery or poor surfaces

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Open Trenches, Pits, Holes

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Crane Position

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Confined Space

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Restricted Vision

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Restricted Access

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Fire or Explosion

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Working at Heights

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Working over water

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Communication method

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Manual Handling

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Noise

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Hazardous Substances

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Fatigue

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Travelling long distances

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

• Other (Not listed above)

  Yes

  No

• Risk Rating for this Hazard

  Extreme Risk

  High Risk

  Moderate Risk

  Low Risk

• Safety Control Measures Used

Physical Safeguards/Controls/Precautions (Including SWPS)

• Electrical

  Yes

  No

• Barricading

  Yes

  No

• Traffic Control Plan

  Yes

  No

• Isolate all stored energy risks (i.e. Air, Water, Hydraulics, Etc..)

  Yes

  No

• Other:

  Yes

  No

Permits Required

• Hot Work

  Yes

  No

• Photograph Permit.

  Media

• Confined Space

  Yes

  No

• Photograph Permit.

  Media

• Working at Heights

  Yes

  No

• Photograph Permit.

  Media

• Crane

  Yes

  No

• Photograph Permit.

  Media

• Fire System Isolation

  Yes

  No

• Photograph Permit.

  Media

• Other:

  Yes

  No

• Photograph Permit.

  Media