Title Page
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Conducted on
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Prepared by (must be completed by management team member)
Feedback
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When obtaining feedback, please ensure at least 3 Safety Leadership Team Members (and Health and Safety Representative if applicable) provide feedback to be captured in the form below
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The equipment risk assessment has been reviewed including current and proposed controls prior to obtaining feedback. Note: Assessment must be reviewed prior to feedback being obtained.
Equipment design
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Observations (capture any key positive aspects and any opportunities to consider for improvement)
- Positive observation
- Opportunities to consider for improvement
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Describe
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Describe
Use of equipment
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Observations (capture any key positive aspects and any opportunities to consider for improvement)
- Positive observation
- Opportunities to consider for improvement
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Describe
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Describe
Risk assessment feedback
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Observations (capture any key positive aspects and any opportunities to consider for improvement)
- Positive observation
- Opportunities to consider for improvement
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Describe
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Describe
Other observations
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Observations (capture any key positive aspects and any opportunities to consider for improvement)
- Positive observation
- Opportunities to consider for improvement
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Describe
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Describe
Sign off - Applicable Management and Store Safety Leadership Team Member (minimum 3 SLT team members required)
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Capture name and role of all management and store safety leadership team members consulted
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Name and role
