Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Risk Assessment & Tailboard

  • Date & Time

  • Work Task

  • Participants

  • Full Name
  • Are any Electrical Hazards present?

  • Electrical Hazard
  • Description

  • Do these hazards require mitigation action?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Can the voltage be safely isolated?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Are there any bare conductors or missing guards?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Will voltage still be present during work tasks?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Voltages present:

  • 5 VDC

  • 24 VDC

  • > 24 VDC

  • 24 VAC

  • 120 VAC

  • 240 VAC

  • > 240 VAC

  • Click if Hydraulic Hazards present?

  • Hydraulic Hazards
  • Description

  • Do these hazards require mitigation action?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Is pressure stored in accumulator?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Is pressure stored in hydraulic ram?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Are there any oil leaks or slip hazards?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Could a pump start up unexpectedly?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Are any Mechanical Hazards present?

  • Mechanical Hazards
  • Description

  • Do these hazards require mitigation action?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Are there moving parts?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Is the walkway free of debris and oil?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Is there a fall hazard?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Is there a crushing hazard?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

  • Could any machines start/ move without warning?

  • High risk hazards should be mitigated to reduce the likely hood or severity of the hazard. List actions taken to reduce identified hazards.

Lock-Out Tag-Out

  • LOTO needed?

  • LOTO
  • What voltage will be isolated?

  • List isolation points

  • Date & Time Locked Out

  • Isolation point locked out & verified Cold: print initials

  • Isolation verified Cold: print initials

  • Perform work

  • Authorize LOTO Release: print initials

  • Date & Time LOTO Released

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.