Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Details
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Task being assessed
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Date of assessment
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Assessor
1. TASK
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Rating if at risk?
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1.1 Task performed Standing?
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Comments/Action
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By Whom
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Risk after action
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1.2 Task Performed seated?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.3 Task Performed kneeling?<br><br>
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.4 Is Load held from trunk?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.5 Does task involve poor posture?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.6 Is twisting of the trunk involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.7 Is stooping involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.9 is lifting/lowering involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.10 Is carrying the loads involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.11 is pushing or pulling involved?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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Rating if at risk?
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1.12 is there sudden movement of the load?
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Comments/Action
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By Whom
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Risk after action
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Rating if at risk?
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1.13 is there sufficient rest or recovery time?
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Comments/Action
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By Whom
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Risk after action
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1.14 is the rate of work set by the job ?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.15 is the task carried out by a team?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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1.16 is the task carried out frequently?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
2. LOAD
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.2 Are loads difficult to grip or grasp?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.3 Are the loads bulky?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.6 Is the load harmful?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.7 Is the centre of gravity offset/unbalanced?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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2.1 Are the loads heavy?
3. WORK AREA
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3.1 Is there restricted work space?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.2 is the floor area obstructed or slippery?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.3 Are there stairs or ramps?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.4 Are there extremes of temperature?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.5 Are there strong air movements?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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3.6 Is the lighting poor?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
4. EMPLOYEE (INDIVIDUAL)
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4.1 Does the job require above average strength?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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4.2 Is the job a hazard to those who are pregnant?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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4.3 Does the work require special training?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
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4.4 Is personal protective equipment required?
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Rating if at risk?
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Comments/Action
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By Whom
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Risk after action
OVERALL ASSESSMENT OF RISK
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Overall risk level?
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Is there a significant risk of injury?
