Information
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Employee Name:-
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Location:-
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Activity/Process:-
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Managed By:-
Section 1
GENERAL
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Does this activity involve Team Lifting?
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Numbers Involved
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Does this activity involve Dual Lifting?
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Does this activity involve Individual Lifting?
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Use the evaluation below to assist in assessing the degree of risk associated with this practice.
EVALUATION
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Movement
- Pushing/Pulling
- Lifting Up/Put Down
- Close to Body
- Reaching Out/Up
- Reaching/Bending/Stretching
- No Twisting
- Slight Twisting
- Considerable Twisting
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Distance
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Frequency
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Duration
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Load
- 0-10 kgs
- 11-20 kgs
- 20+ kgs
- Small/Stable/Compact
- Liquid/Flexible
- Moving Parts
- Clean/Dry/Handles
- Wet/Hot/Slippery
- Sharp/Contaminated
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Information
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Environment
- Indoors/Under Shelter
- Outdoors/Wet/Windy/Rainy
- Clean/Clear Area
- Reasonable Access
- Poor Terrain
- Difficult Terrain
- Excellent Lighting
- Good Lighting
- Poor Lighting
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Injury Potential
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Training
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Experience
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Suitability
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Equipment
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PPE
HAZARDS IDENTIFIED
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Have any significant hazards been identified during this assessment?
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If so, please detail below:-
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a.
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b.
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c.
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d.
CURRENT CONTROLS
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Describe any control measures currently in place:-
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a.
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b.
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c.
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d.
RISK RATING
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Risk Rating Allocated
ACTION REQUIRED
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Have additional control measures been identified to eliminate or reduce the risk to an acceptable standard?
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Describe any control measures required :-
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Who will implement these measures?
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What is the proposed date for implementation?
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Can the process continue until then?
COMPLETION & NOTIFICATION
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HS&S Technician completing this assessment:-
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Have any serious defects been identified and entered onto the database?