Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

MECHANICAL AND PHYSICAL HAZARDS

  • ENTANGLEMENT HAZARDS: Can any persons hair,clothing,jewellery,tools, cleaning brushes or rags become entangled with moving parts of the machine or material such as gears, drive shafts, chains, sprockets, wheels, belts etc? (e.g. single rotating surfaces, projections or gaps, counter rotating parts, rotating and fixed parts, sliding parts, materials in motion)

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • If YES, No further action required. If NO, proceed to next section

  • Is the Risk Score Acceptable?

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • FRICTION AND ABRASION HAZARDS: Can any person receive friction or abrasions through relatively smooth parts operating at high speeds? (e.g. grinder wheels , belt sanders, conveyor belt and its drum and pulleys, material running on a reek or shaft, fast moving ropes or belts)

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • CUTTING AND SHEARING HAZARDS: Is it possible to be cut by any aspect of the plant, the material or as a result of the process? Would the cutting effect be aggravated by the person being unable to move away from the cutter? (e.g. cutting tools, circular saws, milling cutters, rotary knives, disc blades, water jet cutting, high energy laser cutting, edges of a moving sheet of material)

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • STAB AND PUNCTURE HAZARDS: Is it possible for any person's body to be penetrated by flying objects (ejected parts of machinery or materials) or rapidly moving parts of machinery or materials? (e.g. flying spindle or a loom, loose cutter on a vertical spindle milling machine, broken tooling on a press or the bursting of an abrasive wheel, flying waste, ejection of a work piece, molten metal from a die casting machine, sparks generated by welding, explosive powered tools, other ejected debris, sewing machines, drilling machines)

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • IMPACT OR CRUSHING HAZARDS: Is it possible for a person to be struck between one part of machinery moving against another or a part of machinery crushing the person against another fixed structure? ( e.g. hammer ram, power presses, spot welding machine, the closing nip between two platen motions, hand fed platen machines, counterweights)

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • HAZARDS: List the identified hazards here;-

  • COMPRESSED AIR OR HIGH PRESSURE FLUID INJECTION: Is it possible for a person to be injured by the expected or unexpected release of compressed air or high pressure fluid? (e.g. compressed air jets, diesel fuel injectors, paint sprayers and high pressure hydraulic systems)

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • RELEASE OF POTENTIAL ENERGY: Does the plant have any sources that could cause injury either during operation, maintenance or cleaning? (e.g. energy stored in springs, the release of pressure, objects falling under force or gravity such as falling counterweights, parts falling from racks or conveyors, unrestrained keys falling from keyways)

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • MOBILE PLANT HAZARDS: Is there any risk of Rollover, Falling, / losing load, Crushing, Collision, Inappropriate use, Instability, Exceeding safe working loads / limits, Immersion, Fire, or Excessive Speed?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • ISOLATION AND EMERGENCY SHUT- OFF: Are emergency cut - off devices, fire suppression devices, isolation switches or control devices fitted and appropriate to enable the immediate use in an emergency situation? Do they prevent the operator or another person 'overriding' the safety controls?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

ELECTRICAL HAZARDS

  • ELECTRICAL SHOCK: Is there any risk of electric shock or electrical burns to a person from this plant/machinery due to; Exposed or unprotected live conductors or contacts, Damaged electrical cables, Incorrectly labeled or unguarded junction boxes/electrical cabinets, Ingress of water or other conducting medium, The build up of electrostatic energy, Cables run through water or other conducting medium, L lack of detection/protection (e.g. surge protection, ELCB, RCD), inadvertent damage to electrical cables through use?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • CONTACT: Is there a risk due to the possibility of this plant/machinery, Contacting overhead power-lines or accidentally contacting/damaging electrical cables during operation?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • ELECTRICAL FIRE: Is there a risk of electrical fire due to, Electrical shorting causing a fire in the plant, Overloading ('piggybacking') of power sources, The ignition of a flammable atmosphere, excessive or dangerous temperatures generated , The build up of electrostatic energy, Chemicals used in or near the machine igniting, Burning or explosion and emission of ignition sources (embers, excessive heat, electrical sparks etc)?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • BATTERIES/STORED ENERGY: Is there a risk to any person due to the presence of charge storing batteries (in their use, storage, recharging, and handling) or capacitors and accumulators?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

CHEMICAL HAZARDS

  • FIRE OR EXPLOSION HAZARDS: Is there a risk of injury /illness due to chemicals in, on or near the plant that could explode or burn. Could fuel sources be ignited by the plant, material or by - product of its use (i.e. sparks). Can the chemical materials used ignite or sustain combustion?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • EXPOSURE HAZARDS: Is there a risk of injury / illness due to; exhaust emissions, including mists, fumes, dusts; direct exposure / contact causing chemical burns; direct exposure / contact causing thermal burns; indirect exposure / contact causing thermal burns (e.g. pipes); potential effects through injection, absorption or ingestion?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • ENVIRONMENTAL HAZARDS: Is it possible to create an environmental problem through chemical spillage, seepage, leakage; Release to the atmosphere

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

MANUAL HANDLING HAZARDS

  • MACHINE DESIGN: Is it possible for injury to occur due to poor posture; confined or cramped operating conditions; poor visibility of the operator by others, blind spots on plant/machinery

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • PHYSICAL: Is it possible that injury may occur due to repetitive movement; manual handling movement (push, pull, bend, twist, lift, overreaching)?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

OTHER HAZARDS

  • NOISE: Are people exposed to load or excessive noise levels?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • THERMAL: Can someone come into contact with hot parts and material?

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

  • OTHER:

  • HAZARDS: List the identified hazards here;-

  • Place photographs of hazards here:

  • EXISTING CONTROLS: List the current controls here;-

  • Place photographs of existing controls here (if applicable):

  • MANAGED RISK SCORE: Using the risk calculator score the risks with the existing controls in place. Place score here;-

  • Is the Risk Score Acceptable?

  • If YES, No further action required. If NO, proceed to next section

  • CONTROL TYPE: Using the Hierarchy of Controls - Can I ELIMINATE the risk? If NOT what is the next level of control to be implemented:? Place your answer/s here:-

  • RECOMMENDED CONTROL TREATMENTS: What additional controls do I need to put in place? Place your answer here;-

  • RESIDUAL RISK SCORE: Using the risk calculator score the risk as if the NEW controls were in place. Place score here;-

ACTION PLAN

  • ACTION REQUIRED: (Enter details here)

  • RESPONSIBILITY: (Who is required to undertake this task?)

  • COMPLETION DATE FOR THIS TASK

  • REVIEW DATE OF THIS ACTION

  • ACTION REQUIRED: (Enter details here)

  • RESPONSIBILITY: (Who is required to undertake this task?)

  • COMPLETION DATE FOR THIS TASK

  • REVIEW DATE OF THIS ACTION

  • ACTION REQUIRED: (Enter details here)

  • RESPONSIBILITY: (Who is required to undertake this task?)

  • COMPLETION DATE FOR THIS TASK

  • REVIEW DATE OF THIS ACTION

  • ACTION REQUIRED: (Enter details here)

  • RESPONSIBILITY: (Who is required to undertake this task?)

  • COMPLETION DATE FOR THIS TASK

  • REVIEW DATE OF THIS ACTION

  • ACTION REQUIRED: (Enter details here)

  • RESPONSIBILITY: (Who is required to undertake this task?)

  • COMPLETION DATE FOR THIS TASK

  • REVIEW DATE OF THIS ACTION

  • ACTION REQUIRED: (Enter details here)

  • RESPONSIBILITY: (Who is required to undertake this task?)

  • COMPLETION DATE FOR THIS TASK

  • REVIEW DATE OF THIS ACTION

AUTHORISATION

  • RISK ASSESSMENT TEAM LEADER TO SIGN OFF

  • DATE OF COMPLETION

  • APPROVING AUTHORITY TO SIGN OFF

  • DATE OF APPROVAL

  • RISK ASSESSMENT 2 YEAR REVIEW BY:

  • DATE OF LAST REVIEW

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.