Louis Trial Task Specific Hazard Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Hazard Assessment For: (What is the task being undertaken?)

• Photograph the Area

  Media

• Area Where The work is to be done

• Draw area if applicable, draw on specific hazards

  Drawing

• Yes

  No

  N/A

CHEMICAL HAZARD

• CHEMICAL HAZARD

  Safe

  At Risk

  N/A

• Name of Chemical if not Listed (Type Name)

• Name Of Chemical Being Used

  Select petrol Diesel LPG Mineral Turpentine White Spirit Methylated Spirits Spray Paint or tins solvent/adhesive Chemical Cleaners Oils PCB's CRC Asbestos concrete and concrete dust Concrete curing agents or retarders Epoxy Grouts Gib dust/ Plaster Dust Fluorescent Tubes

  • petrol
  • Diesel
  • LPG
  • Mineral Turpentine
  • White Spirit
  • Methylated Spirits
  • Spray Paint or tins
  • solvent/adhesive
  • Chemical Cleaners
  • Oils
  • PCB's
  • CRC
  • Asbestos
  • concrete and concrete dust
  • Concrete curing agents or retarders
  • Epoxy Grouts
  • Gib dust/ Plaster Dust
  • Fluorescent Tubes

• Threats and Consequences to Persons Using Chemical

  Select exposure to spill Fire/Explosion Asphysiation Toxic Poisoning Skin Chemical Burns Eye Damage Corrosion Cold Burns Heat Burns Carsonogenic

  • exposure to spill
  • Fire/Explosion
  • Asphysiation
  • Toxic Poisoning
  • Skin Chemical Burns
  • Eye Damage
  • Corrosion
  • Cold Burns
  • Heat Burns
  • Carsonogenic

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise)

  Eliminate

  Isolate

  Minimise

• Control Measure to be implimented (Pick)

  Select Clean up Use in Well ventilated Area install engineered solution to ventilate the area Protect Skin and Eyes with PPE equipment Handle with care Minimise Quantities Gas Testing Personal Hygiene Vapour Barrier Cold Water Supply Bag/Tag & Dispose Respirator/Breathing Apparatus

  • Clean up
  • Use in Well ventilated Area
  • install engineered solution to ventilate the area
  • Protect Skin and Eyes with PPE equipment
  • Handle with care
  • Minimise Quantities
  • Gas Testing
  • Personal Hygiene
  • Vapour Barrier
  • Cold Water Supply
  • Bag/Tag & Dispose
  • Respirator/Breathing Apparatus

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other Control Measure if not listed (Type)

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

RISK to PUBLIC

• Risk to Public

  Safe

  At Risk

  N/A

Gravitation Hazard (Dropping Items or falls etc)

• Source of gravitational hazard (Pick)

  Select scaffolding ladders and ladder platforms saw horse planks canopy lifting devices working at height demolition manual handling ceiling tiles load bearing walls glass removal lifting jacks Elevated Work platforms cranes

  • scaffolding
  • ladders and ladder platforms
  • saw horse
  • planks
  • canopy
  • lifting devices
  • working at height
  • demolition
  • manual handling
  • ceiling tiles
  • load bearing walls
  • glass removal
  • lifting jacks
  • Elevated Work platforms
  • cranes

• Other source of gravitational hazard if not listed

• Threats and consequence from gravitational issue (pick)

  Select fall off slips, trips and falls fall onto something else hit by falling object back injuries head injuries damage to asset

  • fall off
  • slips, trips and falls
  • fall onto something else
  • hit by falling object
  • back injuries
  • head injuries
  • damage to asset

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) (Pick)

  Eliminate

  Isolate

  Minimise

• Control measure to be implemented (Pick)

  Select secure scaffolds secure ladders secure tools isolate zones certified cranes certified strops certified chains certified scaffolds correct bracing correct lifting get help to lift protective barriers notifiable work? trained and competent people for task certified chain lifter correctly rated lifting equipment certified turner qualified persons to work at height or under direct supervision by qualified person

  • secure scaffolds
  • secure ladders
  • secure tools
  • isolate zones
  • certified cranes
  • certified strops
  • certified chains
  • certified scaffolds
  • correct bracing
  • correct lifting
  • get help to lift
  • protective barriers
  • notifiable work?
  • trained and competent people for task
  • certified chain lifter
  • correctly rated lifting equipment
  • certified turner
  • qualified persons to work at height or under direct supervision by qualified person

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Electrical Hazard

• N/A

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Safe

  Select Eliminate Isolate Minimise

  • Eliminate
  • Isolate
  • Minimise

• Source of Electrical hazard (Pick)

  Select power tools extension leads static electricity mains power exposed cables Multi boxes temporary power supply old wiring damaged fittings distribution boards faulty tools generators buried cables

  • power tools
  • extension leads
  • static electricity
  • mains power
  • exposed cables
  • Multi boxes
  • temporary power supply
  • old wiring
  • damaged fittings
  • distribution boards
  • faulty tools
  • generators
  • buried cables

• Other source of electrical hazard if not listed

• Threats and consequence for people working with or around electrical issues ( pick)

  Select electrocution ignition sources short circuits asset damage

  • electrocution
  • ignition sources
  • short circuits
  • asset damage

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) ( Pick)

  Eliminate

  Isolate

  Minimise

• Control measures to be implemented (Pick)

  Select RCDs isolation zones maintainance 3 monthly tagged equipment consult power authority inspections of equipment before use keep electrical tools and leads dry

  • RCDs
  • isolation zones
  • maintainance
  • 3 monthly tagged equipment
  • consult power authority
  • inspections of equipment before use
  • keep electrical tools and leads dry

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Thermal Hazard (Heat Sources)

• Source of thermal hazard (Pick)

  Select the sun(sun stroke,heat stroke and sun burn) welding grinders power tools welded surfaces heat guns blow torch hot water steam LPG heaters petrol engines Diesel engines hot exhausts torch down gas cutting chemical reactions smoking

  • the sun(sun stroke,heat stroke and sun burn)
  • welding
  • grinders
  • power tools
  • welded surfaces
  • heat guns
  • blow torch
  • hot water
  • steam
  • LPG
  • heaters
  • petrol engines
  • Diesel engines
  • hot exhausts
  • torch down
  • gas cutting
  • chemical reactions
  • smoking

• Other source of thermal hazard if not listed

• Threats and consequence for people working with or around thermal hazard ( Pick)

  Select ignition sources from flammable vapours and building materials skin burn hot and cold electrocution explosion injuries friction burns asset damage chemical burns

  • ignition sources from flammable vapours and building materials
  • skin burn hot and cold
  • electrocution
  • explosion injuries
  • friction burns
  • asset damage
  • chemical burns

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) (Pick)

  Eliminate

  Isolate

  Minimise

• Control measures to be implemented (Pick)

  Select exclude people from the hazard zone that are not involved in the task sun block, hat etc. isolate the area control and remove the build up of flammable vapours minimise exposure use the correct tool for the job use tools correctly fire extinguishers or fire hose reels complete hot works permit/ register

  • exclude people from the hazard zone that are not involved in the task
  • sun block, hat etc.
  • isolate the area
  • control and remove the build up of flammable vapours
  • minimise exposure
  • use the correct tool for the job
  • use tools correctly
  • fire extinguishers or fire hose reels
  • complete hot works permit/ register

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Kinetic Hazard (Power tools etc.)

• Source of kinetic harm (Pick)

  Select skill saw nail gun power tool moving vehicle flying debris jack hammers hiab cranes people moving into ares crane/hooks chains/swinging loads powder actuated tool concrete vibrator Buzzer drop saw chain saw

  • skill saw
  • nail gun
  • power tool
  • moving vehicle
  • flying debris
  • jack hammers
  • hiab cranes
  • people moving into ares
  • crane/hooks chains/swinging loads
  • powder actuated tool
  • concrete vibrator
  • Buzzer
  • drop saw
  • chain saw

• Other Source of other kinetic hazard if not listed

• Threats and consequence for people working with or around kinetic hazard (Pick)

  Select injury from tool electric discharge ignition sources collision between person/vehicle, vehicle/vehicle, person/hardware striking structures rolling down slopes hearing damage being struck by object

  • injury from tool
  • electric discharge
  • ignition sources
  • collision between person/vehicle, vehicle/vehicle, person/hardware
  • striking structures
  • rolling down slopes
  • hearing damage
  • being struck by object

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) (Pick)

  Eliminate

  Isolate

  Minimise

• Control measures to be implemented (Pick)

  Select isolation barriers security zone signs licensed operator exclude flammables protective clothing hard hats safety boots eye/face mask goggles safety glasses hi visibility vests hearing protection pedestrian zones

  • isolation barriers
  • security zone
  • signs
  • licensed operator
  • exclude flammables
  • protective clothing
  • hard hats
  • safety boots
  • eye/face mask
  • goggles
  • safety glasses
  • hi visibility vests
  • hearing protection
  • pedestrian zones

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Pressure Hazard (compressed air or water boasters etc.

• Source of pressure hazard (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Other source of pressure hazard if not listed

• Threats and consequence for people working with or around kinetic hazard (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) (Pick)

  Eliminate

  Isolate

  Minimise

• Control measure to be implemented (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Radiation Hazard ( The sun and welding etc.)

• Source of radiation hazard (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Other Source of radiation hazard if not listed

• Threats and consequence for people working with or around kinetic hazard

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) (Pick)

  Eliminate

  Isolate

  Minimise

• Control measure to be implemented (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Vibration Hazard (hand held Kangos/Breakers etc.)

• Source of Vibration hazard (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Other source of vibration hazard if not listed

• Threats and consequence for people working with or around vibration hazard

  Yes

  No

  N/A

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) (Pick)

  Eliminate

  Isolate

  Minimise

• Control measure to be implemented (pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Reason Why Control Measure taken (Pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Environment Hazard (Rain/Wind)

• Source of Environmental hazard ( Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Other source of environmental hazard if not listed

• Threats and consequence for people working with or around kinetic hazard (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Risk of injury before control measures implemented (Slide to desired Risk Rating)

• Control Measure to be used (Eleminate, Isolate, Minimise) (Pick)

  Eliminate

  Isolate

  Minimise

• Control measure to be implemented (Pick)

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Reason why control measure taken (pick)

  Select Likelyhood of injury is low Likely hood of injury is moderate likelyhood in jury is high Likelyhood of injury is extreem Cost of Elimating the hazard is too high The cost of isolating the hazard is too high The chances of a fatality is low The Chances of a fatality is moderate the chances of a fatality is high The chances of a fatality is extreem

  • Likelyhood of injury is low
  • Likely hood of injury is moderate
  • likelyhood in jury is high
  • Likelyhood of injury is extreem
  • Cost of Elimating the hazard is too high
  • The cost of isolating the hazard is too high
  • The chances of a fatality is low
  • The Chances of a fatality is moderate
  • the chances of a fatality is high
  • The chances of a fatality is extreem

• Other control measure if not listed

• Amended Risk Rating after Control Measure Implement (slide to desired risk rating)

Name of person/team involved in this task are to Sign to confirm their acceptance and compliance with this Task Specific Hazard Assessment

• Name of Person Responsible for Implementing Control Measures

  Sign

• Name of Person

  Sign

• Name of Person

  Sign

• Name of Person

  Sign

• Name of Person

  Sign

• Name of Person

  Sign

• Name of person

  Sign

• Name of Person

  Sign

• Name of Person

  Sign

• Name of Person

  Sign

• Name of Person

  Sign