Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Checklist

ENTANGLEMENT

  • Can anyone’s hair, clothing, gloves, necktie, jewelry etc. become entangled with moving parts of the plant, or materials in motion?

CRUSHING

  • Can anyone be crushed due to:<br><br>a) material falling off the plant?

  • b) uncontrolled or unexpected movement of the plant or its load?

  • c) lack of capacity for the plant to be slowed, stopped, or immobilized?

  • d) the plant tipping or rolling over?

  • e) parts of the plant collapsing?

  • f) coming in contact with moving parts of the plant during testing, inspection, operation, maintenance, cleaning, or repair?

  • g) being thrown off or under the plant?

  • h) being trapped between the plant and materials or fixed structures?

  • i) other factors not mentioned?

CUTTING, STABBING & PUNCTURING

  • Can anyone be cut, stabbed, or punctured due to: <br><br>a) coming in contact with sharp or flying objects?

  • b) coming in contact with moving parts of the plant during testing, inspection, operation, maintenance, cleaning, or repair of the plant?

  • c) the plant, parts of the plant or work pieces disintegrating?

  • d) work pieces being ejected?

  • e) the mobility of the plant?

  • f) uncontrolled or unexpected movement of the plant?

  • g) other factors not mentioned?

SHEARING

  • Can anyone’s body parts be sheared between two parts of the plant, or between a part of the plant and a work piece or structure?

FRICTION

  • Can anyone be burnt due to contact with moving parts or surfaces of the plant, or material handled by the plant?

STRIKING

  • Can anyone be struck by moving objects due to: <br><br>a) uncontrolled or unexpected movement of the plant or material handled by the plant?

  • b) the plant, parts of the plant or work pieces disintegrating?

  • c) work pieces being ejected?

  • d) mobility of the plant?

  • e) other factors not mentioned?

HIGH PRESSURE FLUID

  • Can anyone come into contact with fluids under high pressure?

ELECTRICAL

  • Can anyone be injured by electrical shock or burnt due to?<br><br>a) the plant contacting live electrical conductors?

  • b) the plant working in close proximity to electrical conductors?

  • c) overload of electrical circuits?

  • d) damaged or poorly maintained electrical leads and cables?

  • e) damaged electrical switches?

  • f) water near electrical equipment?

  • g) lack of isolation procedures?

  • h) other factors not mentioned?

EXPLOSION

  • Can anyone be injured by explosion of gases, vapors, liquids, dust or other substances, triggered by the operation of the plant or materials?

SLIPPING, TRIPPING AND FALLING

  • Can anyone using the plant, or in the vicinity of the plant, slip, trip or fall due to:<br><br>a) uneven or slippery work surfaces?

  • b) poor housekeeping, e.g., swarf in the vicinity of the plant, spillage not cleaned up?

  • c) obstacles being placed in the vicinity of the plant?

  • d) inadequate access methods?

  • e) inadequate edge protection?

  • f) fragile roofs?

  • g) other factors not mentioned?

ERGONOMIC Note: For more information refer to the Manual Handling Code of Practice.

  • Can anyone to be injured due to: <br><br>a) poorly designed seating?

  • b) repetitive body movement?

  • c) constrained body posture or the need for excessive effort?

  • d) design deficiency causing mental or psychological stress?

  • e) inadequate or poorly placed lighting?

  • f) lack of consideration given to human error or human behavior?

  • g) mismatch of the plant with human traits and natural limitations?

  • g) other factors not mentioned?

SUFFOCATION

  • Can anyone be suffocated due to lack of oxygen, restricted space or atmospheric contamination?

HIGH TEMPERATURE OR FIRE

  • Can anyone come into contact with objects at high temperatures?

  • Can anyone be injured by fire?

TEMPERATURE (THERMAL COMFORT)

  • Can anyone suffer ill-health due to exposure to high or low temperatures?

OTHER HAZARDS

  • Can anyone be injured or suffer ill-health from exposure to: <br><br>a) chemicals?

  • b) toxic gases or vapors?

  • c) fumes?

  • d) dust?

  • e) noise? Note: For more information refer to the Victorian Noise Code of Practice

  • f) vibration?

  • g) radiation?

  • h) other factors not mentioned?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.