MacWest

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Name of Company

• Title of person completing this assessment:

• Reference:

• Scope:

• Date & Time of Assessment:

  Date

• Name of person completing this assessment:

• Mobile No. of person completing this assessment:

• Location of Assessment:
  Address

• Signature:

  Sign

Reassessment of site for repetitive works

• Is the work carried out at a frequency of 6 months or less at this location?<br>If ‘yes’ you must reassess the site on each occasion and sign and date the form below;<br>If ‘No’ you must complete a new form.

  Yes

  No

  N/A

• Date of reassessment:

  Date

• Signed:

  Sign

• Date of reassessment:

  Date

• Signed:

  Sign

• Date of reassessment:

  Date

• Signed:

  Sign

• Date of reassessment:

  Date

• Signed:

  Sign

• Date of reassessment:

  Date

• Signed:

  Sign

• Hazard Classification Chart

  

• Potential Hazard

  Select Electrical Slip Trip Hazardous Materials Confined Space Working at heights Noise Traffic area Overhead hazards Heat Source In wall/underground services Lone worker Manual Handling Moving Machinery Hot Works Fire/Explosion Uneven Surfaces Pressure Systems Flooding Restricted Access Working above or near Water Other

  • Electrical
  • Slip
  • Trip
  • Hazardous Materials
  • Confined Space
  • Working at heights
  • Noise
  • Traffic area
  • Overhead hazards
  • Heat Source
  • In wall/underground services
  • Lone worker
  • Manual Handling
  • Moving Machinery
  • Hot Works
  • Fire/Explosion
  • Uneven Surfaces
  • Pressure Systems
  • Flooding
  • Restricted Access
  • Working above or near Water
  • Other

SITE SPECIFIC RISK ASSESSMENT FORM

• Identified Hazard

• Probability

  A

  B

  C

  D

  E

• Consequence

  1

  2

  3

  4

  5

• Class of Risk

  High

  Significant

  Medium

  Low

• Control Measures

• Identified Hazard

• Probability

  A

  B

  C

  D

  E

• Consequence

  1

  2

  3

  4

  5

• Class of Risk

  High

  Significant

  Medium

  Low

• Control Measures

• Identified Hazard

• Probability

  A

  B

  C

  D

  E

• Consequence

  1

  2

  3

  4

  5

• Class of Risk

  High

  Significant

  Medium

  Low

• Control Measures

• Identified Hazard

• Probability

  A

  B

  C

  D

  E

• Consequence

  1

  2

  3

  4

  5

• Class of Risk

  High

  Significant

  Medium

  Low

• Control Measures

• REVIEWED BY:

  Sign