Employee Details
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Manual Task Assessed:
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Employee Name:
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Prepared by: LGIS Injury Prevention Consultant
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Location
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LGA:
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Department:
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Job Role:
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Conducted on
General Physical Demands
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If other, please list:
Manual Task Risk Assessment
Manual Task 1
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Manual Task
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Work location:
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Average hours per day
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Required PPE:
- Long pants and sleeves
- Protective Footwear
- Hearing protection
- Eye protection
- Face shield
- Reflective wear
- Falls protection
- Harness
- Chaps
- Gloves
- Hard hat
- Waders
- Disposable protective suit
- Respiratory protection
- Sun protection (hat)
- Other
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If other; please list:
Do the actions and posture involve:
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Holding loads away from trunk (30cm or greater)
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Reaching upwards or load handling above shoulder height
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Bending forward or handling below mid-thigh height
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Twisting
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Sideways bending or load handling by one hand
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Long carrying distance
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Pushing or pulling
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Sudden jerky movements
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Exposure to whole-body vibration
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Exposure to hand-arm vibration
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
Are the loads:
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Difficult to grasp
- Yes
- No
- N/A
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Unstable or unpredictable
- Yes
- No
- N/A
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A person or animal
- Yes
- No
- N/A
Are the movement repetitive or sustained
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Gripping of objects/tools/controls
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Wrist movements with objects/tools/controls
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Elbow movements with objects/tools/controls
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Shoulder movements with objects/tools/controls
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Neck movements
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Kneeling, squatting or crouching, crawling
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Sitting
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Standing
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Walking or climbing
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Lifting
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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Other
- N/A
- Sedentary
- Light
- Medium
- Heavy
- Very Heavy
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If other, please list
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Additional Comments/Notes
Equipment Checklist
Please details the equipment used and its weight
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Equipment 1
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 2
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 3
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 4
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 5
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 6
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 7
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 8
-
undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 9
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
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Equipment 10
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undefined
- 0-4.5kgs
- 4.5-9kgs
- 9-22kgs
- 22-45kgs
- >45kgs
Agreement
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Summary:
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Identified Manual Task Risks:
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Recommendations: