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?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.