Information

  • Employee Name:-

  • Location:-

  • Activity/Process:-

  • Managed By:-

Section 1

GENERAL

  • Does this activity involve Team Lifting?

  • Numbers Involved

  • Does this activity involve Dual Lifting?

  • Does this activity involve Individual Lifting?

  • Use the evaluation below to assist in assessing the degree of risk associated with this practice.

EVALUATION

  • Movement

  • Distance

  • Frequency

  • Duration

  • Load

  • Information

  • Environment

  • Injury Potential

  • Training

  • Experience

  • Suitability

  • Equipment

  • PPE

HAZARDS IDENTIFIED

  • Have any significant hazards been identified during this assessment?

  • If so, please detail below:-

  • a.

  • b.

  • c.

  • d.

CURRENT CONTROLS

  • Describe any control measures currently in place:-

  • a.

  • b.

  • c.

  • d.

RISK RATING

  • Risk Rating Allocated

ACTION REQUIRED

  • Have additional control measures been identified to eliminate or reduce the risk to an acceptable standard?

  • Describe any control measures required :-

  • Who will implement these measures?

  • What is the proposed date for implementation?

  • Can the process continue until then?

COMPLETION & NOTIFICATION

  • HS&S Technician completing this assessment:-

  • Have any serious defects been identified and entered onto the database?

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.