Task Description

What activity will you be performing?


Are you fit to perform the required task?

Do you understand the job - has it been explained sufficiently?

Are you competent to do the work and familiar with the equipment?

Are the tools and equipment in a safe condition?

Have you informed others who may be affected by your work?

Risks - Assess if any of the following are risks to your task

List the risks & what controls you will use to reduce the risks in the text box if different to the defaults provided

GRAVITY - falling objects, working at height, slips, trips

*Dropping equipment: Wear safety boots, perform lift with at least 2 people.

MASS - pulling, pushing, sliding, being hit by vehicles/objects

*Moving equipment: Use a trolley, plan route; *Sliding equipment pinch points: take care when folding handles down, wear suitable gloves to protect fingers

HUMAN MOVEMENT - bending, lifting, carrying

*Back Injury: Stretch before starting lift, plan the lift, perform lift with at least 2 people.

ELECTRICAL - electrocution, damaged cables

*Low voltage cable risk: Inspect all cables before use; seek permission to power on equipment.

MECHANICAL - cutting, crushing, entanglement

*Sharp rail/cardboard box edges: Wear suitable gloves.

NOISE/VIBRATION - A/Cs, computer equipment, other machinery

*Data Centre Background Noise: Wear suitable ear protection if working in DC for extended period, perform work remotely outside room where possible.

ISOLATED WORKER - Working unaccompanied

*Check in with Supervisor every 1 hr via agreed method

THERMAL - hot, cold

PRESSURE/VACUUM - lifting floor tiles

STORED ENERGY - spings, flywheels, counterweights

RADIATION - UV sunlight

FIRE/EXPLOSION - ignition sources, flammable waste, packaging

ASPHYXIATION - lack of oxygen, fire suppresents

ENVIRONMENTAL - earth/air/water impacts, heat, cold, exposure

DESIGN - Hazards/impacts associated with design of products

VEHICLES - vehicle > vehicle / vehicle > person collisions


Equipment - Will you need any of the following


General Tools - Screw Drivers, hammers, extensions?


Personal Protective Equipment

Which of the following PPE will be required?

Safety Boots



Ear plugs

Correct PPE Clothing


Hard Hats


Sign Off
I have considered all elements of this Work that needs to be done!
Cleaning Manager
Safety Officer of site
Select date

Please send this assessment to and to the Safety Officer of the site you are working at!for filing

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.