Information

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Operator Training

2: TRAINING

  • Is a Licence or Training needed to operate this plant?

  • Details:

  • Is a Trade Certificate needed to operate this plant?

  • Details:

  • Is there a SOP associated with this plant?

  • Details:

  • Is there an Induction procedure associated with this plant?

  • Details:

  • List of related Standards, ACOP's, SOP's, Operating manuals, Documents.

Hazards & Controls

3: HAZARDS, CONTROLS & IMPROVEMENTS

Mechanical Energy

  • Can someone/something become entangled in moving parts?

  • Details:

  • Existing control measures in place:

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Can someone/something become crushed between objects?

  • Details:

  • Existing control measures in place:

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Can someone/something get Cuts, Stabbed, Abrasions or Puncture wounds from using this plant?

  • Details:

  • Existing control measures in place:

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Can someone/something become amputated from using this plant?

  • Details:

  • Existing control measures in place:

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Can someone/something become injured due to friction while using this plant?

  • Details:

  • Existing control measures in place:

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Potential Energy

  • Is there any loads greater than 5kg?

  • Details:

  • Existing control measures in place to contain load:

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any Springs?

  • Details:

  • Existing control measures in place to maintain integrity?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any Pneumatics?

  • Details:

  • Existing control measures in place to maintain integrity?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any Hydraulics?

  • Details:

  • Existing control measures in place to maintain integrity?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any Parts that could eject?

  • Details:

  • Existing control measures in place to maintain integrity?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any Rotating parts?

  • Details:

  • Existing control measures in place to maintain integrity?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there anything that could drop to another level?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there anything that could tip over?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there anything that could swing?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there anything that could slide/roll?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Kinetic Energy

  • Can someone fall to another level?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Can plant or something on it move suddenly and/or unexpectedly?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Can this item fall apart due to wear & tear?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Fluid Energy

  • Are there fluids under high pressure?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any confined spaces where any quantity of fluid build up could cause drowning and/or entrapment?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Electrical Energy

  • Are there any electrical cables 240v or greater?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are they in good condition?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Have they been tested and tagged?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Will water come into contact with these cables?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is power required while unit is being maintained?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is there a risk of Lightning Strikes while using this unit?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Chemical Energy

  • Are any flammable chemicals used in conjunction with this unit?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are any flammable/hazardous chemicals stored on this unit?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Acoustic Energy

  • During operation, does the noise interrupt conversations?

  • Average Noise reading generated during normal operation: db(A)

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is there intermittent high level noise?

  • Peak noise reading generated during normal operation: db(A)

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is there impact noise? (from hitting, striking)

  • Peak noise reading generated: db(A)

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Vibration Energy

  • Does whole body vibration occur?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is there Hand/Arm vibration?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Ergonomic Factors

  • Is there any controls or displays?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any operating procedures for use of controls?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any repetitive movements?

  • Details of movements and continuity:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any seating requirements?<br>

  • Details and timeframe:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is Manual Handling required?<br>

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • During daylight operation, is artificial lighting required?<br>

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • During night operation, is artificial lighting required?<br>

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Thermal Energy

  • Are there any HOT parts?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is there an Engine?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is heat generated through friction or moving parts?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Radiation Energy

  • Is anyone subjected to radiation via laser?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is anyone subjected to radiation via welding arc?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is anyone subjected to radiation via UV?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is anyone subjected to radiation via Microwaves?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is anyone subjected to radiation via X-Rays?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is anyone subjected to radiation via Non-ionising (UV)?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Biological Energy

  • Are there waste products associated with this plant?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Is there any bacterial waste?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are there any exhaust fumes?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Can dirt/rubbish/waste accumulate within the plant?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

  • Are special disposal methods needed to dispose of waste produced by this plant?

  • Details:

  • Existing control measures in place?

  • Risk Score before controls: 1= Low, 10=Catastrophic

  • Improvements needed to ensure safety:

  • Risk Score after controls implemented:

  • Is this an acceptable level of risk?

  • Why?

Plant Details

1: PLANT DETAILS

  • Plant Description

  • Plant Identifier #

  • Has plant been entered into asset register?

  • Make

  • Model

  • Serial Number

  • Licence/Registration number:

  • Used for

  • Used by

Controls

4: EXISTING CONTROLS

Summary of existing controls

  • Controls in place:

  • - Elimination
  • Control in place:

  • - Substitution
  • Controls in place:

  • - Isolation
  • Controls in place:

  • - Engineering
  • Controls in place:

  • - Administrative
  • Controls in place:

  • - PPE

Action Plan

5: RECOMMENDED IMPROVEMENTS

  • Description of improvement, person responsible, timeframe, date of completion & signed off.

  • - Improvement
  • Description of improvement:

  • Person responsible:

  • Date to be completed by:

  • Actual date of completion:

  • Name of person completing improvement:

Media

6: PHOTOS/DRAWINGS of PLANT

  • Photos of plant:

  • - Photo
  • Description of photo:

  • Drawing(s) of plant:

  • - Drawing
  • Description of drawing

Communications

7: COMMUNICATION of ASSESSMENT

  • Client Representative:

  • - Client
  • Comments:

  • Time/Date:

  • Name & Position:

  • Company Safety Representative:

  • - Safety Rep
  • Comments:

  • Time/Date:

  • Name & Position:

  • Company Employee:

  • - Worker
  • Comments:

  • Time/Date:

  • Name & Position:

  • Company Management:

  • - Management
  • Comments:

  • Time/Date:

  • Name & Position:

  • Closed out:

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