Title Page

  • Task / Process Reviewed

  • Site

  • Risk Assessment No. / Risk Manager Review No.

  • Conducted on

  • Scope of Assessment

  • Assessment Leader and Team Members

  • Description of area/process/equipment/task:

  • Take a picture of the plant/equipment being assessed

  • For each identified hazard, use the tables below to assess the risk and assist in the selection of appropriate controls.

Entanglement

  • Can a person's hair, clothing, gloves, necktie, jewellery, cleaning brush or rag become entangled with moving parts of the plant or equipment?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Crushing

  • Can a person be crushed due to:<br>a) Falling objects/materials?<br>b) Uncontrolled or unexpected movement of the plant, equipment or loads?<br>c) Lack of capacity for plant or machinery to be slowed, stopped or immobilised?<br>d) Plant or equipment tipping or rolling over?<br>e) Parts of the plant or equipment collapsing?<br>f) Coming into contact with moving parts during testing, inspection, operation, maintenance, cleaning or repair?<br>g) Being thrown off or under the plant or equipment?<br>h) Being trapped beneath plant, materials or fixed structures?<br>If yes for mobile plant, complete traffic management risk assessment (03-20-04) and insert assessment number.<br> <br>If yes for stacking and/or racking of materials, complete stacking (03-19-07) and/or racking(03-19-06) risk assessment and insert assessment number.

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Cutting or Stabbing

  • Can anyone be cut, stabbed or punctured due to:<br>a) coming into contact with sharp or flying objects?<br>b) coming into contact with moving parts of the plant during testing, inspection, operation, maintenance, cleaning or repair of the plant?<br>c) the plant, parts of the plant or work pieces disintegrating?<br>d) work pieces being ejected?<br>e) the mobility of the plant?<br>f) uncontrolled or unexpected movement of the plant?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Shearing

  • Can anyone’s body parts be sheared between any two parts of the plant, or between a part of the plant and a work piece or structure?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Friction

  • Can anyone be burnt due to contact with moving parts or surfaces of the plant, or material handled by the plant?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Striking

  • Can anyone be struck by moving objects due to:<br>a) uncontrolled or unexpected movement of the plant?<br>b) the plant, parts of the plant or work pieces disintegrating?<br>c) work pieces being ejected?<br>d) mobility of the plant?<br> <br>If yes for mobile plant, complete traffic management risk assessment (03-20-04) and insert assessment number.

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

High Pressure Fluid or Gas

  • Can anyone come into contact with fluids or gas under high pressure, due to plant failure or misuse of the plant?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Electrical

  • Can anyone be injured by electrical shock or burn due to:<br>a) the plant contacting live electrical conductors?<br>b) the plant working in close proximity to electrical conductors?<br>c) overload of electrical circuits?<br>d) damaged or poorly maintained electrical leads and cables?<br>e) damaged electrical switches?<br>f) water near electrical equipment?<br>g) lack of isolation procedures?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Explosion

  • Can anyone be injured by explosion of gasses, vapours, liquids, dusts or other substances, triggered by the operation of the plant or by material handled by the plant?<br><br>

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Slipping and Tripping

  • Can anyone using the plant, or in the vicinity of the plant, slip, trip or fall due to:<br>a) uneven or slippery work surfaces?<br>b) poor housekeeping e.g. offcuts, cables, hoses obstructing walkways, spills not cleaned up?<br>c) obstacles being placed in the vicinity of the plant?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Falling

  • Can anyone fall from a height due to:<br>a) lack of a proper work platform?<br>b) lack of proper stairs or ladders?<br>c) lack of guardrails or other suitable edge protection?<br>d) unprotected holes, penetrations or gaps?<br>e) poor floor or walking surfaces, such as the lack of a slip-resistant surface?<br>f) steep walking surfaces?<br>g) collapse of the supporting structure?<br>If yes, complete working at heights risk assessment (03-10-04) and insert assessment number.

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Manual Tasks

  • Can anyone be injured due to:<br>a) poorly designed seating?<br>b) poorly designed operator controls?<br>c) high forces?<br>d) repetitive movements? <br>e) awkward body posture or the need for excessive effort?<br>f) Vibration?<br>If yes, complete manual tasks risk assessment (03-01-04) and insert assessment number.

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Confined Spaces

  • Does the area/task involve a confined space?<br>If yes, complete confined space risk assessment (03-08-05) and insert assessment number.

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Temperature (thermal comfort)

  • Can anyone suffer ill health due to extreme temperature or change of weather?<br>If yes, complete working in extreme temperatures risk assessment (03-22-03) and insert assessment number.

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Chemicals

  • Can anyone suffer ill health or health loss due to exposure to chemicals?<br>If yes, complete chemical risk assessment (03-35-04a/b) for each identified chemical and insert assessment number.

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Other Hazards

  • Can anyone be injured due to:<br>a) noise?<br>b) inadequate or poorly placed lighting?<br>c) failure to select plant that is suitable for its intended use?<br>d) contact with hot or cold parts of plant?<br>e) exposure radiation or other emissions released by the plant?<br>f) lack of operator competency?<br>g) Exposure to asbestos?<br>h) Other factors not mentioned above?

  • What is the hazard description?

  • What are the current controls?

  • What is the current risk score?

  • What action is required? (Include proposed controls)

  • What is the future risk score?

  • What is the risk manager action item number?

Persons Consulted

  • What are there names?

  • How did you consult with them? (Email, meeting, phone call or toolbox etc.)

Reviewer Details

  • Name;

  • Position;

  • Add signature

  • Select date

  • Scheduled Re-assessment

  • Risk Manager Action ID;

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.