Title Page
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Conducted on
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Prepared by
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Location
Operation Details
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Department
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Assessment Number
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Location and Operation
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Assessor Name/Signature
Risk Matrix
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Falls from Height
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Impact, Cut or Crushing
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Stab, Cut or Graze
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Slip, Trip or fall
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Vibration
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Scald, Heat, Fire
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Cold
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Immersion
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Radiation
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Noise
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Electrical
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Dust/Fibre
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Fume
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Bacterial, Biological, Viral
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Gas/Vapour
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Flying Debris
- Cranium
- Ears
- Eyes
- Respiratory
- Face
- Whole Head
- Hands
- Arms
- Feet
- Legs
- Skin
- Abdomen
- Whole Body
- None Applicable
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Summary of Special Equipment Required:
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Special Considerations (e.g. physical effort, visibility, communications, hygiene requirements, compatibility of PPE)
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Manufacturer/Supplier Consulted
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Date Consulted
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Recommended Equipment (specify exactly type and relevant standard – e.g. British Standard, CE etc)
