Title Page
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Client
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Site Address:
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Date
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Prepared by
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Personnel
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SWMS Employed on this site:
- OHS006a Domestic Premises
- OHS006b Emergency and Exit Lights
- OHS006c Workplace Test and Tag
- OHS006d Working from Ladders
- OHS006e Elevated Work Platforms
- OHS006f Fire Services
- OHS006g Working Alone Working in Isolation
Possible Hazards
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Traffic
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Mobile plant & equipment
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Working at heights/ladders
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Weather
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Housekeeping/Workplace Layout
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Lighting
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Electrical
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Manual handling
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Site access
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Risk Assessment Rating Prior to Control (as per OHS008)
- Extreme
- High
- Moderate
- Low
- No Risk
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Noise
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Domestic premises
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
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Other
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Risk Assessment Rating Prior to Control (as per OHS008)
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Risk Assessment Rating Prior to Control (as per OHS008)
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Control Measures
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Initialled by Responsible Person
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Other Workers Consulted
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Control Measure Assessed as Sufficient
Authorisation
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The authorisation of this site specific risk assessment is an acknowledgement of Jim's Test & Tag's commitment to all aspects of work/occupational health and safety and is authorised by:
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This is to verify that having conducted works in accordance with the SWMS indicated above, the controls have been found to provide adequate protection and that no other safety issues have been identified. If the controls have been found to be inadequate the Divisional Franchisors are to be notified via the feedback form on the Intranet. If a high risk has been identified, the Divisional Franchisors are to be contacted immediately.
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Additional controls required?
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Client signature to acknowledge receipt of this site specific risk assessment
