PLANT & EQUIPMENT HAZARD CHECKLIST

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Certificate / License No

• Location
  Address

PLANT / EQUIPMENT DETAILS

• What Type of Plant or Equipment

  Select Forklift Manitou Moffatt Truck Scaffold Hand-tool - Battery Hand-tool - Electrical Hand-tool - Air

  • Forklift
  • Manitou
  • Moffatt
  • Truck
  • Scaffold
  • Hand-tool - Battery
  • Hand-tool - Electrical
  • Hand-tool - Air

• Registration / Plant Identification No.

• Maintenance Frequency

  Weekly

  Monthly

  Quarterly

  Yearly

ENTANGLEMENT

• Can a person’s hair, clothing, gloves, necktie, jewelry, cleaning brush or rag or any other items become entangled with moving parts of the plant / equipment?

  Yes

  No

  N/A

CRUSHING

• Can anyone be crushed due to Material falling off the plant / equipment?

  Yes

  No

  N/A

• Can anyone be crushed due to Uncontrolled or unexpected movement of the plant / equipment?

  Yes

  No

  N/A

• Can anyone be crushed due to Lack of capacity for the plant / equipment to be slowed, stopped or immobilised?

  Yes

  No

  N/A

• Can anyone be crushed due to The plant / equipment tipping or rolling over?

  Yes

  No

  N/A

• Can anyone be crushed due to Parts of the plant / equipment collapsing?

  Yes

  No

  N/A

• Can anyone be crushed due to Coming into contact with moving parts of the plant / equipment during testing, inspection, operation, maintenance, cleaning or repair?

  Yes

  No

  N/A

• Can anyone be crushed due to Being thrown off or under plant / equipment?

  Yes

  No

  N/A

• Can anyone be crushed due to Being trapped between the plant / equipment and materials or fixed structures?

  Yes

  No

  N/A

• Can anyone be crushed due to Other factors not mentioned?

  Select Yes No N/A

  • Yes
  • No
  • N/A

CUTTING, STABBING OR PUNCTURING

• Can anyone be crushed due to Coming in contact with sharp or flying objects?

  Yes

  No

  N/A

• Can anyone be crushed due to Coming in contact with moving parts during testing, inspection, operation, maintenance, cleaning or repair?

  Yes

  No

  N/A

• Can anyone be crushed due to The plant, parts of the plant or work pieces disintegrating?

  Yes

  No

  N/A

• Can anyone be crushed due to Work pieces being ejected?

  Yes

  No

  N/A

• Can anyone be crushed due to The mobility of the plant / equipment?

  Yes

  No

  N/A

• Can anyone be crushed due to Uncontrolled or unexpected movement of the plant / equipment?

  Yes

  No

  N/A

• Can anyone be crushed due to Other factors not mentioned?

  Yes

  No

  N/A

STRIKING

• Can anyone be struck by moving objects due to Uncontrolled or unexpected movement of the plant / equipment or material handled by the plant / equipment?

  Yes

  No

  N/A

• Can anyone be struck by moving objects due to The plant / equipment, parts of the plant / equipment or work pieces disintegrating?

  Yes

  No

  N/A

• Can anyone be struck by moving objects due to Work pieces being ejected?

  Yes

  No

  N/A

• Can anyone be struck by moving objects due to Mobility of the plant / equipment?

  Yes

  No

  N/A

• Can anyone be struck by moving objects due to Other factors not mentioned?

  Yes

  No

  N/A

HIGH PRESSURE FLUIDS

• Can anyone come into contact with fluids under high pressure, due to plant / equipment failure or misuse of the plant / equipment?

  Yes

  No

  N/A

ELECTRICAL

• Can anyone be injured by electrical shock or burnt due to The plant / equipment contacting live electrical conductors?

  Yes

  No

  N/A

• Can anyone be injured by electrical shock or burnt due to The plant / equipment working in close proximity to electrical conductors?

  Yes

  No

  N/A

• Can anyone be injured by electrical shock or burnt due to Overload of electrical circuits?

  Yes

  No

  N/A

• Can anyone be injured by electrical shock or burnt due to Damaged or poorly maintained electrical leads and cables?

  Yes

  No

  N/A

• Can anyone be injured by electrical shock or burnt due to Damaged electrical switches?

  Yes

  No

  N/A

• Can anyone be injured by electrical shock or burnt due to Water near electrical equipment?

  Yes

  No

  N/A

• Can anyone be injured by electrical shock or burnt due to Lack of isolation procedures?

  Yes

  No

  N/A

• Can anyone be injured by electrical shock or burnt due to Other factors not mentioned?

  Yes

  No

  N/A

EXPLOSION

• Can anyone be injured by explosion of gases, vapors, liquids, dusts or other substances, triggered by the operation of the plant / equipment or by material handled by the plant / equipment?

  Yes

  No

  N/A

SLIPPING, TRIPPING AND FALLING

• Can anyone using or working near the plant / equipment slip, trip or fall due to Uneven or slippery work surfaces?

  Yes

  No

  N/A

• Can anyone using or working near the plant / equipment slip, trip or fall due to Poor housekeeping e.g. offcuts, cables, hoses obstructing walkways, spills not cleaned up? Obstacles being placed in the vicinity of the plant / equipment?

  Yes

  No

  N/A

HEIGHTS

• Can anyone fall from a height due to Lack of a proper work platform?

  Yes

  No

  N/A

• Can anyone fall from a height due to Lack of proper stairs or ladders?

  Yes

  No

  N/A

• Can anyone fall from a height due to Lack of guardrails or other suitable edge protection?

  Yes

  No

  N/A

• Can anyone fall from a height due to Unprotected holes, penetrations or gaps?

  Yes

  No

  N/A

• Can anyone fall from a height due to Poor floor or walking surfaces, such as the lack of a slip-resistant surface?

  Yes

  No

  N/A

• Can anyone fall from a height due to Collapse of the supporting structure?

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Can anyone fall from a height due to Other factors not mentioned?

  Yes

  No

  N/A

ERGONOMICS

• Can anyone be injured due to Poorly designed seating?

  Yes

  No

  N/A

• Can anyone be injured due to Poorly designed operator controls?

  Yes

  No

  N/A

• Can anyone be injured due to High forces?

  Yes

  No

  N/A

• Can anyone be injured due to Repetitive movements?

  Yes

  No

  N/A

• Can anyone be injured due to Awkward body posture or the need for excessive effort?

  Yes

  No

  N/A

• Can anyone be injured due to Vibration?

  Yes

  No

  N/A

• Can anyone be injured due to Other factors not mentioned?

  Yes

  No

  N/A

COMBINATION OF HAZARDS

• Can anyone be injured due to unexpected start-up, unexpected over-run/over-speed (or similar malfunction) from Failure/disorder of the control system, for example a hydraulic system?

  Yes

  No

  N/A

• Can anyone be injured due to unexpected start-up, unexpected over-run/over-speed (or similar malfunction) from Restoration of energy supply after an interruption?

  Yes

  No

  N/A

• Can anyone be injured due to unexpected start-up, unexpected over-run/over-speed (or similar malfunction) from External influences on electrical equipment?

  Yes

  No

  N/A

• Can anyone be injured due to unexpected start-up, unexpected over-run/over-speed (or similar malfunction) from Other environmental factors (gravity, wind, etc.)?

  Yes

  No

  N/A

• Can anyone be injured due to unexpected start-up, unexpected over-run/over-speed (or similar malfunction) from Errors in the software?

  Yes

  No

  N/A

• Can anyone be injured due to unexpected start-up, unexpected over-run/over-speed (or similar malfunction) from Errors made by the operator?

  Yes

  No

  N/A

OTHER HAZARDS

• Can anyone be injured due to noise?

  Yes

  No

  N/A

• Can anyone be injured due to Inadequate or poorly placed lighting?

  Yes

  No

  N/A

• Can anyone be injured due to Entry into any confined spaces of the plant / equipment?

  Yes

  No

  N/A

• Can anyone be injured due to Failure to select plant that is suitable for its intended use?

  Yes

  No

  N/A

• Can anyone be injured due to Contact with hot or cold parts of plant / equipment?

  Yes

  No

  N/A

• Can anyone be injured due to Exposure to hazardous chemicals, radiation or other emissions released by the plant / equipment?

  Yes

  No

  N/A

• Can anyone be injured due to Lack of operator competency?

  Yes

  No

  N/A

• Can anyone be injured due to Does the plant / equipment have an operator’s manual and log books?

  Yes

  No

  N/A

• Can anyone be injured due to Has the plant / equipment been maintained in accordance with the manufactures recommendations and is there a maintenance record available?

  Yes

  No

  N/A

• Can anyone be injured due to Is all the necessary PPE and information provided with the plant / equipment?

  Yes

  No

  N/A

• Can anyone be injured due to Does the plant / equipment require a specific certificate, license or other form of competency to use, erect or install?

  Yes

  No

  N/A

• Can anyone be injured due to Is the plant / equipment registered with the relevant authority?

  Yes

  No

  N/A

• Can anyone be injured due to Have the chains for use with the plant / equipment been tested and tagged?

  Yes

  No

  N/A

• Can anyone be injured due to the plant / equipment be safely stowed, locked up or safeguarded after hours or when not in use?

  Yes

  No

  N/A

• Can anyone be injured due to Has a risk assessment been carried out for identified hazards associated with the use of plant / equipment on site?

  Yes

  No

  N/A

• Can anyone be injured due to Other factors not mentioned?

  Yes

  No

  N/A