Observation
Are there any hazards?
Select
Signage
Faulty Equipment
Lighting
Fire Equipment
Falls, trips and slips of a person
Hitting objects with a part of the body
Being hit by a moving object
Sound and pressure
Body stressing
Heat, electricity and other environmental factors
Chemicals and other substances
Biological factors
Mental stress
Other and unspecified mechanisms of incident
Environment
Note Only
other
Signage Faulty Equipment Lighting Fire Equipment Falls, trips and slips of a person Hitting objects with a part of the body Being hit by a moving object Sound and pressure Body stressing Heat, electricity and other environmental factors Chemicals and other substances Biological factors Mental stress Other and unspecified mechanisms of incident Environment Note Only other
Falls, trips and slips of a person hazard types.....
Falls from a height
Falls on the same level
Stepping, kneeling or sitting on objects
Hitting objects with a part of the body hazard types.....
Hitting stationary objects
Hitting moving objects
Rubbing and chafing
Being hit by moving objects hazard types....
Select
Being hit by a falling object
Being bitten by an animal
Being hit by an animal
Being hit by a person accidentally
Being trapped by moving machinery or equipment
Being trapped between stationary and moving objects
Exposire Exposure to mechanical vibration
Being hit by moving objects
Being assaulted by a person or persons
Being hit by a falling object Being bitten by an animal Being hit by an animal Being hit by a person accidentally Being trapped by moving machinery or equipment Being trapped between stationary and moving objects Exposire Exposure to mechanical vibration Being hit by moving objects Being assaulted by a person or persons
Sound and pressure hazard types....
Exposure to single sudden sound
Long-term exposure to sounds
Other variations in pressure
Body stressing hazard types....
Muscular stress while lifting, carrying, or putting down objects
Muscular stress while handling objects other than lifting, carrying or putting down
Muscular stress with no objects being handled
Repetitive movement, low muscle loading
Heat, electricity and other environmental factors hazard types....
Select
Contact with hot objects
Contact with cold objects
Exposure to environmental heat
Exposure to environmental cold
Exposure to non-ionising radiation
Exposure to ionising radiation
Contact with electricity
Drowning/immersion
Exposure to other environmental factors
Contact with hot objects Contact with cold objects Exposure to environmental heat Exposure to environmental cold Exposure to non-ionising radiation Exposure to ionising radiation Contact with electricity Drowning/immersion Exposure to other environmental factors
Chemicals and other substances hazard types....
Single contact with chemical or substance
Long term contact with chemicals or substances
Insect and spider bites and stings
Contact with poisonous parts of plant or marine life
Other and unspecified contact with chemical or substance
Biological factors hazard types....
Contact with, or exposure to, biological factors of non-human origin
Contact with, or exposure to, biological factors of human origin
Mental stress hazard types....
Select
Exposure to a traumatic event
Exposure to workplace or occupational violence
Work pressure
Suicide or attempted suicide
Other mental stress factors
Work related harassment and /or workplace bullying
Other harassment
Exposure to a traumatic event Exposure to workplace or occupational violence Work pressure Suicide or attempted suicide Other mental stress factors Work related harassment and /or workplace bullying Other harassment
Other and unspecified mechanisms of incident hazard types....
Slide or cave-in
Vehicle incident
Other and multiple mechanisms of incident
Unspecified mechanisms of incident
Description of other hazard:
Photo(s) of observation
Media
Short description of photo (if accompanying)
Action required:
Action assigned to:
SSEM
Environment
Assets
Property
Any further observations?
Observation
Are there any hazards?
Select
Signage
Faulty Equipment
Lighting
Fire Equipment
Falls, trips and slips of a person
Hitting objects with a part of the body
Being hit by a moving object
Sound and pressure
Body stressing
Heat, electricity and other environmental factors
Chemicals and other substances
Biological factors
Mental stress
Other and unspecified mechanisms of incident
Environment
Note Only
other
Signage Faulty Equipment Lighting Fire Equipment Falls, trips and slips of a person Hitting objects with a part of the body Being hit by a moving object Sound and pressure Body stressing Heat, electricity and other environmental factors Chemicals and other substances Biological factors Mental stress Other and unspecified mechanisms of incident Environment Note Only other
Description of other hazard:
Photo(s) of observation
Media
Short description of photo (if accompanying)
Action required:
Action assigned to:
SSEM
Environment
Assets
Property
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General Inspection
This form is to be used for general inspections
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