Title Page
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Conducted on
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Prepared by
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Location
Hazard Checklist
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If “yes” is the answer to a question in the checklist, the plant, parts of the plant and/or the situation associated with the hazard should be written in the notes section, and a photo uploaded to the media section.
A. Entanglement
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Can anyone’s hair, clothing, gloves, necktie, jewellery, cleaning brushes, rags or other materials become entangled with moving parts of the plant, or materials in motion?
B. Crushing
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Can anyone be crushed due to:
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a. material falling off the plant?
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b. uncontrolled or unexpected movement of the plant or its load?
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c. lack of capacity for the plant to be slowed, stopped or immobilised?
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d. the plant tipping or rolling over?
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e. parts of the plant collapsing?
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f. coming in contact with moving parts of the plant during testing, inspection, operation, maintenance, cleaning or repair?
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g. being thrown off or under the plant?
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h. being trapped between the plant and materials or fixed structures?
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i. other factors not mentioned?
C. Cutting, stabbing and puncturing
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Can anyone be cut, stabbed or punctured due to:
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a. coming in contact with sharp or flying objects?
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b. coming in contact with moving parts of the plant during testing, inspection, operation, maintenance, cleaning or repair of the plant?
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c. the plant, parts of the plant or work pieces disintegrating?
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d. work pieces being ejected?
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e. the mobility of the plant?
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f. uncontrolled or unexpected movement of the plant?
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g. other factors not mentioned?
D. Shearing
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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 structrue?
E. Friction
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Can anyone be burnt due to contact with moving parts or surfaces of the plant, or material handled by the plant?
F. Stricking
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Can anyone be struck by moving objects due to:
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a. uncontrolled or unexpected movement of the plant or material handled by the plant?
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b. the plant, parts of the plant or work pieces disintegrating?
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c. work pieces being ejected?
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d. mobility of the plant?
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e. other factors not mentioned?
G. High Pressure Fluid
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Can anyone come into contact with fluids under high pressure, due to plant failure or misuse of the plant?
H. Electrical
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Can anyone be injured by electrical shock or burnt due to:
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a . the plant contacting live electrical conductors?
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b. the plant working in close proximity to electrical conductors?
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c. overload of electrical circuits?
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d. damaged or poorly maintained electrical leads and cables?
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e . damaged electrical switches?
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f . water near electrical equipment?
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g. lack of isolation procedures?
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h. other factors not mentioned?
I. Explosion
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Can anyone be injured by explosion of gases, vapours, liquids, dusts or other substances, triggered by the operation of the plant or by material handled by the plant?
J. Tripping, slipping and falling
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Can anyone using the plant, or in the vicinity of the plant, slip, trip or fall due to:
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a. uneven or slippery work surfaces?
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b. poor housekeeping, eg. swarf in the vicinity of the plant, spillage not cleaned up?
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c. obstacles being placed in the vicinity of the plant?
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d. other factors not mentioned?
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Can anyone fall from a height due to:
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a. lack of a proper work platform?
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b. lack of proper stairs or ladders?
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c. lack of guardrails or other suitable edge protection?
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d. unprotected holes, penetrations or gaps?
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e. poor floor or walking surfaces, such as the lack of a slip-resistant surface?
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f. steep walking surfaces?
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g. collapse of the supporting structure?
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h. other factors not mentioned?
K. Ergonomic
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Can anyone be injured due to:
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a. poorly designed seating?
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b. repetitive body movement?
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c. constrained body posture or the need for excessive effort?
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d. design deficiency causing mental or psychological stress?
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e. inadequate or poorly placed lighting?
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f. lack of consideration given to human error or human behaviour?
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g. other factors not mentioned?
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h. mismatch of the plant with human traits and natural limitations?
L. Suffocation
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Can anyone be suffocated due to lack of oxygen, or atmospheric contamination?
M. High temperature or fire
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Can anyone come into contact with objects at high temperatures?
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Can anyone be injured by fire?
N. Temperature (thermal comfort)
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Can anyone suffer ill-health due to exposure to high or low temperatures?
O. Other hazzards
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Can anyone be injured or suffer ill-health from exposure to:
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a. chemicals?
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b. toxic gases or vapours?
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c. fumes?
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d. dust?
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e. noise?
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f. vibration?
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g. radiation?
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h. other factors not mentioned?