Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

DETAILS

  • SELECT TASK TO BE ASSESSED

  • Address/Location

PERSONS CARRYING OUT TASK

  • RISK ASSESOR

  • Select date

  • ARE OPERATIVES EXPERIENCED ?

  • OPERATIVE SIGN

  • OPERATIVE SIGN

  • OPERATIVE SIGN

  • OPERATIVE SIGN

PART A: THE WORK PLACE AND WORK ENVIRONMENT

  • Is the space sufficient to allow safe lifting techniques?

  • Are there SLIPPING OR TRIPPING hazards present in the workplace?

  • Is the LIGHTING To allow good visibility for the task?

PART B: THE TASK

  • TASK TITLE

  • Description of task

  • IS THE LIFTING:

  • DOES THE LIFTING INVOLVE:

  • Change of grip ?

  • Twisting of the trunk ?

  • Stooping ?

  • Jerking or sudden movement ?

  • Frequent or sudden movement ?

  • Prolonged effort ?

  • Reaching away from trunk ?

PART G: RISK EVALUATION

  • RISK ASSESSED AS - SELECT

PART H: ACTION PROGRAMME

  • IS THERE ANY ACTION TO BE FOLLOWED UP ?

  • Identified risks please list

  • ADDITIONAL RISK FACTORS

  • OTHER RECOMENDATIONS

  • SAFE TO CARRY OUT TASK ?

  • SIGNATURE OF ASSESSOR

  • Checked and signed off

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.