Plant Hazard Management Form

• Document No.

• Audit Title

  Plant Hazard Management Form

• Store Location

  Blacktown

  Store 2

  Store 3

  Store 4

• Conducted on

  Date

• Prepared by

• If any of the questions result in a Not Safe answer then:
  1. a risk assessment must be conducted using section 3 of this form, and
  2. controls must be devised using section 4 of this form.

Hazard Management Details - General

• Detail the Plant or Equipment

  Select Warehouse Machiney (Includes Forks/Pickers/Turrets Warehouse in General Lifts Hand Tools Ladders Other

  • Warehouse Machiney (Includes Forks/Pickers/Turrets
  • Warehouse in General
  • Lifts
  • Hand Tools
  • Ladders
  • Other

Hazard Identification

Physical Hazards

• Gravitational - falling person

  Safe

  At Risk

  N/A

• Gravitational - falling object / substance

  Safe

  At Risk

  N/A

• Noise

  Safe

  At Risk

  N/A

• Vibration

  Safe

  At Risk

  N/A

• Manual Handling

  Safe

  At Risk

  N/A

• Liquid / air /gas /pressure

  Safe

  At Risk

  N/A

• Fire or explosion

  Safe

  At Risk

  N/A

• Laceration

  Safe

  At Risk

  N/A

• Access / Egress

  Safe

  At Risk

  N/A

• Restricted / Confined Space

  Yes

  No

  N/A

• Operator comfort

  Yes

  No

  N/A

• Air Quality

  Safe

  At Risk

  N/A

Chemical Hazards

• Explosive

  Safe

  At Risk

  N/A

Mechanical / Electrical Hazards

• Flammable gas

  Safe

  At Risk

  N/A

• Flammable Liquid

  Safe

  At Risk

  N/A

• Reactive

  Safe

  At Risk

  N/A

• Toxic

  Safe

  At Risk

  N/A

• Corrosive

  Safe

  At Risk

  N/A

• MSDS Available

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Impact /Crushing

  Safe

  At Risk

  N/A

• Entanglement

  Safe

  At Risk

  N/A

• Laceration

  Safe

  At Risk

  N/A

• Controls - identification & ease of operation

  Yes

  No

  N/A

• Electricity

  Safe

  At Risk

  N/A

Psychological Hazards

• Noise

  Safe

  At Risk

  N/A

• Interruptions

  Safe

  At Risk

  N/A

• Boring Tasks

  Safe

  At Risk

  N/A

• Exposure to assault /verbal abuse

  Safe

  At Risk

  N/A

• Work / KPI's

  Safe

  At Risk

  N/A

• Please use the Risk Assessment Matrix and Risk Rating Chart to achieve these results of those activities deemed At Risk

• What hazards have you identified?

• What could potentially happen (summarise)

• Likelihood (How likely is it to happen?)

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• Consequence (How bad is it likely to be?)

  Severe

  Major

  Moderate

  Minor

  Insignificant

• Establish your Risk Rating

  VH - Notify Senior Management immediately - Corrective action should be taken now

  H - Notify Senior Management immediately - Corrective action ASAP

  M - Notify location manager - is to follow up that corrective action is taken within 7 days

  L - Notify location manager - follow up that corrective action is taken within a reasonable time

Control Strategy

• Please tick your control strategy - Consider more than one control, the last two controls being the least effective)

  Select Elimination Substitution Isolation Engineering Administrative PPE

  • Elimination
  • Substitution
  • Isolation
  • Engineering
  • Administrative
  • PPE

• If controlled immediately list details here

• If longer term controls required list here

• Date to be implemented

  Date

• Employee representative verifies controls are effective

  Sign

• Location Manager verifies controls are effective

  Sign

• Date

  Date