MEWP WORKPLACE RISK ASSESSMENT FORM

• undefined

• JOB NAME, CONTRACTOR AND JOB #

• Date

  Date

• Risk Assessor(s)

• DOES THE ASSESSMENT REPLACE A PREVIOUS ASSESSMENT?

  Yes

  No

  N/A

• WHAT IS THE DATE OF THE PREVIOUS ASSESSMENT

  Date

• Authorized MEWPs

  CLASS 3 TYPE A (SCISSORS)

  CLASS 3 TYPE B (BOOM)

  BOTH TYPES

BUILDING HAZARDS ALL SIDES

• LIST ALL HAZARDS ON THE NORTHSIDE OF BUILDING

• LIST THE CONTROL MEASURES TO BE USED TO ELIMINATE HAZARDS

• LIST ALL HAZARDS ON THE EASTSIDE OF THE BUILDING

• LIST ALL CONTROL MEASURES TO BE USED TO ELIMINATE/REDUCE THE HAZARDS

• LIST ALL HAZARDS ON THE SOUTHSIDE OF THE BUILDING

• LIST ALL CONTROL MEASURES TO BE USED TO ELIMINATE/REDUCE THE HAZARDS

• LIST ALL HAZARDS ON THE WESTSIDE OF THE BUILDING

• LIST ALL CONTROL MEASURES TO BE USED TO ELIMINATE/REDUCE THE HAZARDS

• PRINT NAME