Completion Instructions

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Load Weight/Frequency Graphs

Lifting Operations

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Carrying Operations

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Assessment

Load/Weight Risk Level of Activity

LOW LEVEL OF RISK
The vulnerability of special risk groups (e.g. pregnant women, young workers etc.) should be considered where appropriate.
MEDIUM LEVEL OF RISK
Examine tasks closely
HIGH LEVEL OF RISK
Prompt action needed This may expose a significant proportion of the working population to risk of injury.
VERY HIGH LEVEL OF RISK
Such operations may represent a serious risk of injury and should come under close scrutiny, particularly when the entire weight of the load is supported by one person.

Risk Level

SWL of access equipment (KG)

Maximum combined weight of operator(s), tools and materials (KG)

Declaration

Are there mechanical aids available to prevent or limit the need to perform manual handling activity?

Mechanical aids where available should always be used in preference to manual handling (aids must be suitable to the task and the weight of load)

Detailed Assessment of Task

Does the task involve:

Holding load away from trunk

Level of Risk

Twisting/Leaning

Level of Risk

Vertical Lift Region

Level of Risk

Long carrying distances

Level of Risk

Strenuous pushing or pulling

Level of Risk

Repetitive handling

Level of Risk

Insufficient rest or recovery

Level of Risk

Insufficient rest or recovery

Level of Risk

Insufficient rest or recovery

Level of Risk

The Task: Comments and Control Measures

Detailed Assessment of Load

The Load- are there:

Heavy

Level of Risk

Bulky/Unwieldy

Level of Risk

Difficult to Grasp

Level of Risk

Unstable/Unpredictable (e.g. contain moving parts/liquid)

Level of Risk

Harmful (e.g. sharp/hot)

Level of Risk

The Load: Comments and Control Measures

Detailed Assessment of the Working Environment

The working environment: are there

Constraints on posture

Level of Risk

Floor conditions

Level of Risk

Variations in level

Level of Risk

Obstacles on route

Level of Risk

Hot, cold or humid conditions

Level of Risk

Strong air movements

Level of Risk

Poor lighting conditions

Level of Risk

Working Environment: Comments and Control Measures

Detailed Assessment of the Individual

The Individual: Does the job

Require unusual capability

Level of Risk

Present a hazard to those with health problems

Level of Risk

Present a hazard to those who are pregnant

Level of Risk

The Individual: Comments and Control Measures

Other Factors

Is movement or posture hindered by:

Clothing

Level of Risk

Personnel Protective Equipment

Level of Risk

Other Factors: Comments and Control Measures

Control Measures
Measures in place

Other Measures (Specify)

Additional Measures Required

Additional Measure

Measure

Details

Responsible
Date Due
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.