Plant Risk Assessment

• Prepared by

  Select

• Site name

  Select

• Conducted on

  Date

Plant Information

• Plant Item/Unit Number

• Type of Powered Mobile Plant

  Select

• Type of Power Tool/Equipment

  Select

• Plant Use

• Is it Specified High Risk Plant?

  Yes

  No

  N/A

• High Risk Licence required

  Yes

  No

  N/A

• Is the plant in good working condition and free of damage?

  Yes

  No

  N/A

References

• Risk Matrix Reference

• Hierarchy of Controls Reference

Exposure

• Frequency of Use

  Continuous

  2-3 times a day

  Several times a week

  Once or twice a month

• Duration of use

  8 hours a day

  4 - 8 hours a day

  2 - 4 hours a day

  1 - 2 hours a day

  15 minutes/occasionally

Electricity Contact

• Can anyone be injured by electrical shock or burnt due to damaged or poorly maintained leads, switches or equipment?

  No

  Yes

  N/A

Identified Hazards

• Moving Parts/Plant

  No

  Yes

  N/A

• Hazardous Substances

  No

  Yes

  N/A

• Noise

  Yes

  No

  N/A

• Vibration

  No

  Yes

  N/A

• Height

  No

  Yes

  N/A

• Pressure

  No

  Yes

  N/A

• Potential Roll Over

  No

  Yes

  N/A

• Electricity

  No

  Yes

  N/A

• Confined Space

  No

  Yes

  N/A

• Thermal/Heat

  No

  Yes

  N/A

• Radiation

  No

  Yes

  N/A

• Manual Handling

  No

  Yes

  N/A

• Machine Guard in place

  No

  Yes

  N/A

• Entanglement

  No

  Yes

  N/A

• Slips, Trips, Falls

  No

  Yes

  N/A

• Ergonomics

  No

  Yes

  N/A

• Other

Initial risk rating

• Initial consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Initial likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Initial risk rating

  High

  Medium

  Low

Residual risk rating

• Residual consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Residual likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Residual risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

  • Elimination
  • Substitution
  • Engineering Controls
  • Administrative Controls
  • PPE
  • Other

• Enter other control measures

• Enter description of control measures

PPE - Options

• Select PPE Required

  Select

Actions Required

• Above Controls Implemented

  Yes

  No

  N/A

• Developed Emergency Procedures

  Yes

  No

  N/A

• Ongoing Monitoring

  Yes

  No

  N/A

• Training Required

  Yes

  No

  N/A

• Seek Expert Help

  Yes

  No

  N/A

• Manufacturers Controls Implemented

  Yes

  No

  N/A

• Additional Controls Required - Note

Completion

• Plant is Approved for Use

  Yes

  No

  N/A

• All Required Actions Have Been Implemented

  Yes

  No

  N/A

• Name and Signature

  Sign