Employee Details

  • Manual Task Assessed:

  • Employee Name:

  • Prepared by: LGIS Injury Prevention Consultant

  • Location
  • LGA:

  • Department:

  • Job Role:

  • Conducted on

General Physical Demands

  • %Time spent Sitting

  • %Time spent Standing

  • %Time spent Walking

  • %Time spent Bending

  • %Time spent Lifting

  • %Time spent Other

  • If other, please list:

Manual Task Risk Assessment

Manual Task 1

  • Manual Task

  • Work location:

  • Average hours per day

  • Required PPE:

  • If other; please list:

Do the actions and posture involve:

  • Holding loads away from trunk (30cm or greater)

  • Reaching upwards or load handling above shoulder height

  • Bending forward or handling below mid-thigh height

  • Twisting

  • Sideways bending or load handling by one hand

  • Long carrying distance

  • Pushing or pulling

  • Sudden jerky movements

  • Exposure to whole-body vibration

  • Exposure to hand-arm vibration

Are the loads:

  • Difficult to grasp

  • Unstable or unpredictable

  • A person or animal

Are the movement repetitive or sustained

  • Gripping of objects/tools/controls

  • Wrist movements with objects/tools/controls

  • Elbow movements with objects/tools/controls

  • Shoulder movements with objects/tools/controls

  • Neck movements

  • Kneeling, squatting or crouching, crawling

  • Sitting

  • Standing

  • Walking or climbing

  • Lifting

  • Other

  • If other, please list

  • Additional Comments/Notes

Equipment Checklist

Please details the equipment used and its weight

  • Equipment 1

  • undefined

  • Equipment 2

  • undefined

  • Equipment 3

  • undefined

  • Equipment 4

  • undefined

  • Equipment 5

  • undefined

  • Equipment 6

  • undefined

  • Equipment 7

  • undefined

  • Equipment 8

  • undefined

  • Equipment 9

  • undefined

  • Equipment 10

  • undefined

Agreement

  • Summary:

  • Identified Manual Task Risks:

  • Recommendations:

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.