Title Page
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Equipment
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Asset/Equipment No. (Scan QR code)
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Job/Task
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Prepared by
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Does the activity involve multiple people?
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All persons named?
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All persons named?
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All persons named?
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Conducted on
Before You Start
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Individual Risk Assessments must be completed by RMET before commencing the assigned work. Any risks indentified as MEDIUM or HIGH risk must have a mitigation strategy put in place and re-assessed
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Do you have relevant skills and training for the task?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING https://atoz.amazon.work/safety_observations
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Has action been raised through Dragonfly?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING https://atoz.amazon.work/safety_observations
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Are you familiar with any work instructions relevant?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
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Do you have the correct documents / permits for the task?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
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Do you have the correct PPE for the task?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
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Do you have the correct tools for the task?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
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Have you completed a pre-use inspection on all access equipment?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
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Do you have the correct lockout equipment if the task requires LOTO?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
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*Is all equipment isolated for the entire task?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
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Have you isolated the area to prevent unauthorised access?
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PLEASE REPORT DIRECTLY TO YOUR MANAGER BEFORE CONTINUING
Risk Assessment
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The work instruction may have been created some time ago and conditions may have changed. Select any of the following hazards that may be apparent during this task and identify what controls you will put in place to mitigate the risk then re-assess.
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Risk to others from your work?
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Slips, Trips and Falls
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Falls from Height
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Falling Objects
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Manual Handling Heavy Objects
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Sharp Objects Present?
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Hazardous Substances
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Heat, Fire or Explosion
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
-
A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
-
A continued risk exists, or the safety measures are insufficient! Do not start working and inform your manager! Further approval is required!
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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Entanglement/Entrapment
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
-
A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Electric Shock
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Stored Energy/Unsecure load
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Vehicles
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Dust Inhalation
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Noise Exposure
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Vibration
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Inadequate Lighting
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
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A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
-
A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Additional risk (please specify) Leave blank if None
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Safety control measures
- Bump cap/hard hat
- Hand/Arm protection (gloves, arm guards, etc.)
- Eye/Face protection
- Hearing protection
- Fall protection, fall arrest system
- Respiratory protection (dust, fumes, chemical, smoke)
- Appropriate Tools and Material Obtained
- Lifting equipments
- Cover, block off, heat protection
- LOTO required
- Barricade, tape off, highlight area
- Only utilize trained team members
- Permit to Work
- Additional safety measures
- No control measures
-
A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required! -
Are the safety measures sufficient?
-
A continued risk exists, or the safety measures are insufficient!
Do not start working and inform your manager! Further approval is required!
Review
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Did the work create any additional / unforeseen hazards?
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Sign Off
