PErforM Risk Assessment Tool

• Prepared by

• Location
  Address

• Date of Assessment

  Date

• Work unit/team:

• Positions:

• Names:

• Task description

• Name of task:

• General description:

• Tools or equipment used:

Body Part Selector - Head

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Neck

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Shoulder

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Upper Back

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Elbow

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Wrist / Hand

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Hip / Thigh

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Knee

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Lower Leg

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time

Body Part Selector - Ankle / Foot

• Give each risk factor a score out of five. One (1) is when the risk factor is not present and five (5) is when the risk factor is the most severe level they have experienced

• Exertion - How much force is the person using? – No effort > Maximum force or speed

• Awkward posture - How awkward is the person’s posture? All neutral Postures > Very Uncomfortable

• Vibration - How much are the whole body or hand(s) being vibrated? None > Extreme

• Duration - How long is the action performed for? < 10 Minutes - > 2 Hours

• Repetition - How often are similar actions done? No repetition - < 10s Cycle Time