Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

Document Revisions

  • Document Revisons

  • Document Revision
  • Revised By?

  • Date of Revision

  • Signature of Document Editor

Site Documentation viewed

  • Electrical Drawings

  • Hydraulic Circuits

  • Pneumatic Circuits

  • Mechanical Layouts

  • Operating manuals

  • Maintenance Manuals

  • Safety Instructions

  • Material Safety Data Sheets

Site or Plant Contacts

  • Personnel Interviewed About Machinery

  • Site Contacts
  • Name

  • Position

Purpose of this Assessment

  • Purpose of this assessment is to provide the recipient company with advice and guidance relating to the safety of the plant, equipment or machinery being assessed. All relevant Australian and European standards applicable will be used to assess each hazard.

Motivation of Company requesting this assessment

Service Provided

  • The risk assessment model being used is a widely acceptable form of examination for plant, equipment or machinery and work practices. The approach is a standardized set of approaches governing hazard identification, evaluating that risk posed to personnel. The assessment will give the reader an informed view on how likely a hazard would be to occur and what could be done to mitigate against the hazard occurring in the future.

Phases of machine operation being assessed

  • Transport

  • Cleaning

  • Maintenance / Repair

  • De-commisioning

  • Operation

  • Disposal<br>

  • Installation

  • Assembly / Installation

Basic Machine Limits

  • Manufacturer / OEM

  • Machine Importer or supplier

  • Machine Name

  • Machine Serial Number

  • Are operators trained to use equipment?

  • Who is responsible for maintenance & repair?

  • Who is responsible for cleaning and clearing of jams etc?

  • Are maintenance staff trained on equipment?

  • What is the normal maintenance interval?

  • Is machine being used in it's intended environment?

  • Basic Description of Control System

  • What is the control voltage?

  • What is the main power supply voltage?

  • Does the machine have Hydraulic Controls

  • What is the Hydraulic Pressure in Bar?

  • Does the machine have Pneumatics controls?

  • What is the Compressed Air Pressure in Bar?

Details relating to hazard and tasks

  • Description of all Hazards

  • Hazard
  • Photograph of Hazard

  • Area of Machine associated with hazard?

  • Task or operation?

  • Types of Hazards associated with the task?

  • Hazard Description

Hazard Rating Number - multiply DPH x FE x LO x NP to get HRN - the number determines the Risk Level.

  • DPH - Degree of Possible Harm

  • FE - Frequency of Exposure

  • LO - Likelihood of Occurance

  • NP - Number of Persons affected / in hazardous area

  • HRN - Hazard Rating Number ( LO x FE x DPH x NP = HRN)

Residual Risk Reduction

  • Residual Risk Reduction Measures

  • DPH - Degree of Possible Harm after Risk Reduction

  • FE - Frequency of Exposure after Risk Reduction

  • LO - Likelihood of Occurrence after Risk Reduction

  • NP - Number of Persons affected / in hazardous area

  • HRN - Hazard Rating Number ( LO x FE x DPH = HRN) after Risk Reduction

Category of Control required (AS4024.1501:2014) if Guarding solution requires SRP/CS and not just a mechanical guarding.

  • Severity of Hazard

  • AS4024.1-2014 Category B+1

    Category B - Well Tried Principles - components - designed and constructed to withstand expected influences. Be correctly protected and dimensioned.

    Category 1 - Well Tried Safety Components and principles - widely used with successful components, made and verified for use in safety circuits.

  • Frequency of Hazardous Event

  • Possibility of Avoiding the Hazard(s)

  • AS4024.1-2014 Category 1 (with over-dimensioning and Fault exclusion) or Category 2

    Category B - Well Tried Principles - components - designed and constructed to withstand expected influences. Be correctly protected and dimensioned.

    Category 1 - Well Tried Safety Components and principles - widely used with successful components, made and verified for use in safety circuits.
    OR
    Category 2 - Category B shall apply + safety functions shall be checked by the machine control system at suitable intervals. If manual checks are performed then this should be documented. Check shall generate a fault indication if a fault is detected

  • AS4024.1-2014 Category 2 (with over-dimensioning and Fault exclusion) or Category 3

    Category B - Well Tried Principles - components - designed and constructed to withstand expected influences. Be correctly protected and dimensioned.

    Category 2 - Category B shall apply + safety functions shall be checked by the machine control system at suitable intervals. If manual checks are performed then this should be documented. Check shall generate a fault indication if a fault is detected
    OR
    Category 3 - Category B shall apply + shall be designed so that a single fault in any part of the SRP/CS does not lead to a loss of safety function. Wherever reasonably practicable, the single fault shall be detected at or before the next demand upon the safety function.

  • Possibility of Avoiding the Hazard(s)

  • AS4024.1-2014 Category 3

    Category B - Well Tried Principles - components - designed and constructed to withstand expected influences. Be correctly protected and dimensioned.

    Category 3 - Category B shall apply + shall be designed so that a single fault in any part of the SRP/CS does not lead to a loss of safety function. Wherever reasonably practicable, the single fault shall be detected at or before the next demand upon the safety function.

  • AS4024.1-2014 Category 4

    Category B - Well Tried Principles - components - designed and constructed to withstand expected influences. Be correctly protected and dimensioned.

    Category 4 - Category B shall apply + a single fault in SRP/CS does not lead to loss of safety function and the single fault is detected at or before the next demand of the safety functions i.e. immediately or at the end of the machine operating cycle. If detection is not possible then an accumulation of faults shall not lead to a loss of safety function.

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.