Culligan Dynamic Risk assessment

• Site conducted

  Select

• Conducted on

  Date

• What was the unsafe act that has been stopped

  Select Unsafe Manual Handling Unsafe Working at Height Unsafe access/ egress Unsafe work equipment Environmental failure Unsafe Working with hazardous materials Unsafe Pedestrian location Other

  • Unsafe Manual Handling
  • Unsafe Working at Height
  • Unsafe access/ egress
  • Unsafe work equipment
  • Environmental failure
  • Unsafe Working with hazardous materials
  • Unsafe Pedestrian location
  • Other

• Please summarise the unsafe act that has been stopped

• Person stopping the unsafe act

STOP

• Is there a risk assessment available for this task?

  Yes

  No

• Please complete a suitable risk assessment

• Please review the risk assessment

• Who was involved in the unsafe act (use initials only)?

• Why was the task stopped?

  Select Unsafe operation Unsafe behaviors Unsafe work area Unsafe equipment Unsafe materials

  • Unsafe operation
  • Unsafe behaviors
  • Unsafe work area
  • Unsafe equipment
  • Unsafe materials

• Provide information regarding the operation and why it was considered unsafe.

• What unsafe behaviours were witnessed?

• Why was the work area unsafe? Please provide details

• Has the equipment been inspected prior to use?

  Yes

  No

• What makes the equipment unsafe? Please provide details

• What materials are being used that are unsafe?

THINK

• How can this act be made safe?

  Select The operation can be improved The behaviour can be improved The equipment can be improved The work area can be improved The material used can be improved

  • The operation can be improved
  • The behaviour can be improved
  • The equipment can be improved
  • The work area can be improved
  • The material used can be improved

• What aspect of the operation should be improved?

• How can the behavior be improved?

  Select Short discussion Full re-training Tool-box Talk Other

  • Short discussion
  • Full re-training
  • Tool-box Talk
  • Other

• Please describe what other action is required to improve behaviour

• How can the equipment be improved?

  Select Quarantined and engineer called to fix Different equipment to be used Other

  • Quarantined and engineer called to fix
  • Different equipment to be used
  • Other

• Please describe other improvement to the equipment

• How can the work area be improved?

  Select Improvements in housekeeping Removing hazards Improvement in local environment Other

  • Improvements in housekeeping
  • Removing hazards
  • Improvement in local environment
  • Other

• Describe what other improvement is required in the work area to make the act safe

• Can another material be used instead?

  Yes

  No

• What material can be used instead?

ACT

• Have the improvements considered above been communicated to the individuals involved in the unsafe act?

  Yes

  No

• Please sign to confirm that you have received the improvements communication

  Sign

• Can the task now be completed safely?

  Yes

  No

• Continue to THINK how the task can be made safe - If it is not possible do not continue.

REVIEW

• Was this task made safer from the improvements detailed above?

  Yes

  No

• Can this improvement be a permanent corrective action for this type of task?

  Yes

  No

• Please raise actions on how these actions can become permanent, for example , retraining, process improvements, risk assessment review etc

Sign off

• Full name

  Sign