Information
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Site name
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Conducted on
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Prepared by
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Location
Observations
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Observations of the work activity
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Enter details of activity
Hazards Identified
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List all the hazards identified
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Take picture of hazard if possible
Who might be harmed?
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Who can be harmed or affected by these risks?
Description
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Advise description of risks
Risk rating
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Severity
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Probability of occurance
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Risk rating
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Reference: Risk Matrix
Implementation Plan
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Enter description of implementation plan
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List who will be responsible for actioning the implementation plan
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When will this be actioned and completed by?
Completion
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Risk assessment has been completed
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Risks reported have been resolved and completed
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Signature