New Area Pre-Start & Site Specific Risk Assessment

• Site conducted

  Select

• Client :

• Contractor:

• Location:

• Date/Time:

  Date

HEALTH AND SAFETY CONSIDERATIONS DISCUSSED

• Maps Provided and Discussed

  Yes

  No

  N/A

• What are the high risk areas?

• High risk areas identified, discussed and marked on the map?

  Yes

  No

  N/A

• What are the environmental issues?

• What are the operator issues ?

• Emergency Assembly Point

• Physical GPS Coordinates
  Address

Site Risk Assessment

Add Hazard

• Risk Matrix

  

• Hazard

• Initial Risk Rating

  Select E - (Extreme Risk) - If an incident was to occur, it would likely be permanent, debilitating injury or death would result H - (High Risk) If an accident was to occur, it would be likely that an injury requiring medical treatment would result M - (Moderate Risk) If an incident was likely to occur, there would be some chance that an injury would result L - (Low Risk) If an incident was to occur, there would be little likelihood that an injury would result

  • E - (Extreme Risk) - If an incident was to occur, it would likely be permanent, debilitating injury or death would result
  • H - (High Risk) If an accident was to occur, it would be likely that an injury requiring medical treatment would result
  • M - (Moderate Risk) If an incident was likely to occur, there would be some chance that an injury would result
  • L - (Low Risk) If an incident was to occur, there would be little likelihood that an injury would result

• Controls (How are we going to reduce this Risk? Eliminate, Minimise)

• Residual Risk Rating - after the controls are in place

  Select E - (Extreme Risk) - If an incident was to occur, it would likely be permanent, debilitating injury or death would result H - (High Risk) If an accident was to occur, it would be likely that an injury requiring medical treatment would result M - (Moderate Risk) If an incident was likely to occur, there would be some chance that an injury would result L - (Low Risk) If an incident was to occur, there would be little likelihood that an injury would result

  • E - (Extreme Risk) - If an incident was to occur, it would likely be permanent, debilitating injury or death would result
  • H - (High Risk) If an accident was to occur, it would be likely that an injury requiring medical treatment would result
  • M - (Moderate Risk) If an incident was likely to occur, there would be some chance that an injury would result
  • L - (Low Risk) If an incident was to occur, there would be little likelihood that an injury would result

• Controls Hierachy

  Select Eliminate Substitution Isolation Engineering Administration PPE

  • Eliminate
  • Substitution
  • Isolation
  • Engineering
  • Administration
  • PPE

• Photo of Hazard (if required)

  Media

Confirm Understanding

• Foreman Signature

  Sign

• Supervisor Signature

  Sign
Add signature

• Additional Signature

  Sign