Information
-
Document No.
-
Audit Title
-
Site/Facility Code
-
Conducted on
-
Conducted By
-
Prepared by
-
Location
1.0 Entanglement
-
1.1 Can clothing, gloves, jewellery or any other items become entangled in the moving parts of this item?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk Score with controls?
2.0 Crushing - can anyone be crushed due to?
-
2.1 Material falling off plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.2 Uncontrolled or unexpected movement of plant or its load?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.3 Lack of capacity for the plant to be slowed, stopped or immobilised?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.4 The plant tipping or rolling over?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.5 Parts of the plant collapsing?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.6 Coming in contact with moving parts of the plant during testing inspection, operation & maintenance?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.7 Cleaning or repair?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.8 Being thrown off or under the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
-
2.9 Being trapped between the plant and materials or fixed structures?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
3.0 Friction & Abrasion
-
3.1 Can anyone be burnt due to contact with moving parts or material handled by the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls?
4.0 Shear
-
4.1 Can anyone's body parts be sheared between two parts of the plant or between a part of the plant and a work piece or structure?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures in place?
-
Risk score with controls
5.0 Cutting, Stabbing & Puncturing - Can anyone be cut, stabbed or punctured due to?
-
5.1 Coming in contact with sharp or flying objects
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current Control Measures
-
Risk score with controls
-
5.2 Coming in contact with moving parts of the plant during testing, inspection, operation, maintenance, cleaning or repair of the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current Control Measures
-
Risk score with controls
-
5.3 The plant, parts of the plant work pieces disintegrating?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current Control Measures
-
Risk score with controls
-
5.4 Work pieces being ejected?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current Control Measures
-
Risk score with controls
-
5.5 The mobility of the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current Control Measures
-
Risk score with controls
-
5.6 Uncontrolled or unexpected movement of the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current Control Measures
-
Risk score with controls
6.0 Striking - Can anyone be struck by moving objects due to?
-
6.1 Uncontrolled or unexpected movement of or material handled by the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
6.2 The plant, part of the plant work pieces disintegrating?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
6.3 Work pieces being ejected?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
6.4 Mobility of the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
7.0 High Pressure Fluid
-
7.1 Can anyone come into contact with fluids under high pressure, due to plant failure or misuse of the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
8.0 Electrical - Can anyone be injured by electrical shock or burn due to?
-
8.1 The plant contacting live electrical conductors?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
8.2 The plant working in close proximity to electrical conductors?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
8.3 Over loads of electrical circuits?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
8.4 Damaged or poorly maintained electrical leads and cables?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
8.5 Damaged electrical switches?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
8.6 Any water near electrical equipment?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
-
8.7 Lack of isolation procedures?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures?
-
Risk score with controls?
9.0 Explosion
-
9.1 Can anyone be injured by explosion of gases, vapours, liquids, dust or other substances, triggered by the operation of the plant or by material handled by the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
10.0 Slipping, Tripping & Falling - Can anyone using plant or in the vicinity of plant, slip or fall due to?
-
10.1 Uneven or slippery work surfaces?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.2 Obstacles placed in the vicinity of the plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.3 Poor housekeeping eg. offcuts, cables, hoses, obstructing walkways, piles not cleaned up?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
Any other factors not mentioned?
-
Can anyone fall from a height due to the following:
-
10.5 Lack of proper work platform?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.6 Lack of proper stairs or ladders?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.7 Lack of guard-rails or other suitable edge protection?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.8 Unprotected holes, penetrations or gaps?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.9 Poor floor or walking surfaces such as the lack of slip-resistant surfaces?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.10 Steep walking surfaces?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
10.11 Collapse of supporting structure?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
11.0 Ergonimics / Manual Handling - Can anyone be injured due to?
-
11.0 Poorly designed seating?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
-
11.2 Poorly designed operators controls?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
-
11.3 Repetitive body movement?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
-
11.4 Awkward body posture or the need for excessive effort?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
-
11.5 Design deficiency causing mental or psychological stress?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
-
11.7 Vibration?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
12.0 Extremes of Temperature
-
12.1 Can anyone come into contact with objects at high temperatures?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
-
12.2 Can anyone suffer ill-health due to high or low temperatures?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk Score
-
Current control measures
-
Risk score with controls
13.0 Chemicals, Noise Vibration & Airborne Contaminants - Can anyone be injured or suffer ill-health from exposure to?
-
13.1 Chemicals?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.2 Biological?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.3 Toxic gases or vapours?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.4 Fumes?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.5 Dusts?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.6 Noise?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.7 Vibration?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.8 Radiation?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.9 Pressure or vacuum?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
13.10 Hazardous materials? eg. Asbestos
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
14.0 Traffic - Can anyone be injured by exposure to traffic when?
-
14.1 Working at the site (traffic within 3 metres of worksites)
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
15.0 Combination of Hazards - Can anyone be injured due to unexpected start-up, unexpected over-run/overspeed from?
-
15.1 Failure/disorder of the control systems? eg hydraulic system
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
15.2 Restoration of energy supply after interruption?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
15.3 External influences on electrical equipment?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
15.4 Errors made by the operator?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
15.5 Errors in software?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
Any other environmental factors? eg wind, gravity
16.0 Other Hazards - Can anyone be injured due to?
-
16.1 Entry into confined space?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
16.2 Failure to select plant that is suitable for its intended use?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
16.3 Contact with hot or cold parts of plant?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls
-
16.4 Lack of operator competency?
-
Gippsland Water Corporate Risk Matrix
-
Likelihood
-
Consequence
-
Risk score
-
Current control measures
-
Risk score with controls