Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Details
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Task being assessed
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Date of assessment
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Assessor
1. TASK
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1.1 Task performed Standing?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.2 Task Performed seated?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.3 Task Performed kneeling?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.4 Is Load held from trunk?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.5 Does task involve poor posture?
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If the movements of the operatives are unhindered, there is no risk, if the operatives adopt restricted postures because of the space available, or workstation design, then the rating is low, if the posture is restricted, then the rating should be medium, if the posture is severely restricted, then the rating should be high
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.6 Is twisting of the trunk involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.7 Is stooping involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.8 Are stooping and twisting combined?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.9 is lifting/lowering involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.10 Is carrying the load involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.11 is pushing or pulling involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.12 is there movement of the load?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.13 is there sufficient rest or recovery time?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.14 is the rate of work set by the job ?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.15 is the task carried out by a team?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.16 is the task carried out frequently?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
2. LOAD
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2.1 Are the loads heavy?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.2 Are loads difficult to grip or grasp?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.3 Are the loads bulky?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.4 Unstable or floppy?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.5 Are contents likely to shift?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.6 Is the load harmful?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.7 Is the centre of gravity offset/unbalanced?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
3. WORK AREA
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3.1 Is there restricted work space?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.2 is the floor area obstructed or slippery?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.3 Are there stairs or ramps?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.4 Are there extremes of temperature?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.5 Are there strong air movements?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.6 Is the lighting poor?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
4. EMPLOYEE (INDIVIDUAL)
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4.1 Does the job require above average strength?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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4.2 Is the job a hazard to those who are pregnant?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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4.3 Does the work require special training?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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4.4 Is personal protective equipment required?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
OVERALL ASSESSMENT OF RISK
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Overall risk level?
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Is there a significant risk of injury?
