Plant Hazard ID & Risk Assessment

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1: PLANT DETAILS

• Plant Description

  Media

• Plant Identifier #

• Has plant been entered into asset register?

  Yes

  No

  N/A

• Make

• Model

• Serial Number

• Licence/Registration number:

  Yes

  No

  N/A

• Used for

• Used by

2: TRAINING

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

  Yes

  No

  N/A

• Details:

• Is a Trade Certificate needed to operate this plant?

  Yes

  No

  N/A

• Details:

• Is there a SOP associated with this plant?

  Yes

  No

  N/A

• Details:

• Is there an Induction procedure associated with this plant?

  Yes

  No

  N/A

• Details:

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

3: HAZARDS, CONTROLS & IMPROVEMENTS

Mechanical Energy

• Can someone/something become entangled in moving parts?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

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

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Can someone/something become crushed between objects?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Potential Energy

• Is there any loads greater than 5kg?

  Yes

  No

  N/A

• Details:

• Existing control measures in place to contain load:

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

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any Springs?

  Yes

  No

  N/A

• Details:

• Existing control measures in place to maintain integrity?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any Pneumatics?

  Yes

  No

  N/A

• Details:

• Existing control measures in place to maintain integrity?

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

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any Hydraulics?

  Yes

  No

  N/A

• Details:

• Existing control measures in place to maintain integrity?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any Parts that could eject?

  Yes

  No

  N/A

• Details:

• Existing control measures in place to maintain integrity?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any Rotating parts?

  Yes

  No

  N/A

• Details:

• Existing control measures in place to maintain integrity?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there anything that could drop to another level?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there anything that could tip over?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there anything that could swing?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there anything that could slide/roll?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Kinetic Energy

• Can someone fall to another level?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Fluid Energy

• Are there fluids under high pressure?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Electrical Energy

• Are there any electrical cables 240v or greater?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are they in good condition?

  Yes

  No

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Have they been tested and tagged?

  Yes

  No

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Will water come into contact with these cables?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is power required while unit is being maintained?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Chemical Energy

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Acoustic Energy

• During operation, does the noise interrupt conversations?

  Yes

  No

  N/A

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

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is there intermittent high level noise?

  Yes

  No

  N/A

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

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Peak noise reading generated: db(A)

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Vibration Energy

• Does whole body vibration occur?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is there Hand/Arm vibration?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Ergonomic Factors

• Is there any controls or displays?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any operating procedures for use of controls?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any repetitive movements?

  Yes

  No

  N/A

• Details of movements and continuity:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any seating requirements?<br>

  Yes

  No

  N/A

• Details and timeframe:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is Manual Handling required?<br>

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Thermal Energy

• Are there any HOT parts?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is there an Engine?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is heat generated through friction or moving parts?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

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• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Radiation Energy

• Is anyone subjected to radiation via laser?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is anyone subjected to radiation via welding arc?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is anyone subjected to radiation via UV?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is anyone subjected to radiation via Microwaves?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is anyone subjected to radiation via X-Rays?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 5
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
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  • 7
  • 8
  • 9
  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Biological Energy

• Are there waste products associated with this plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 7
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Is there any bacterial waste?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
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  • 7
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
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  • 7
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  • 9
  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• Are there any exhaust fumes?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
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  • 5
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  • 7
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  • 9
  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

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

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
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  • 10

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
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  • 7
  • 8
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  • 10

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

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

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:

  Date

• Actual date of completion:

  Date

• Name of person completing improvement:

  Sign

6: PHOTOS/DRAWINGS of PLANT

• Photos of plant:

- Photo

• Description of photo:

  Media

• Drawing(s) of plant:

- Drawing

• Description of drawing

  Drawing

7: COMMUNICATION of ASSESSMENT

• Client Representative:

- Client

• Comments:

• Time/Date:

  Date

• Name & Position:

  Sign

• Company Safety Representative:

- Safety Rep

• Comments:

• Time/Date:

  Date

• Name & Position:

  Sign

• Company Employee:

- Worker

• Comments:

• Time/Date:

  Date

• Name & Position:

  Sign

• Company Management:

- Management

• Comments:

• Time/Date:

  Date

• Name & Position:

  Sign

• Closed out: