PLANT RISK ASSESSMENT - Peter Brown Pty Limited

• Audit Title

• Plant used

  Select HITACHI EX40-U-3 EXCAVATOR 2009 HITACHI EX60 EXCAVATOR HITACHI ZX120 2001 HITACHI EX200 1998 HITACHI ZX130 2009 BOBCAT S130 SKID STEER 1996 TOYOTA SDK8 TOYOTA SKID STEER 2011 KOBELCO SK210 8lc KOMATSU PC35MR-13T ROLLER 1995 DYNA PAK ROLLER INTERNATIONAL TRUCK

  • HITACHI EX40-U-3 EXCAVATOR 2009
  • HITACHI EX60 EXCAVATOR
  • HITACHI ZX120 2001
  • HITACHI EX200 1998
  • HITACHI ZX130 2009
  • BOBCAT S130 SKID STEER 1996
  • TOYOTA SDK8
  • TOYOTA SKID STEER 2011
  • KOBELCO SK210 8lc
  • KOMATSU PC35MR-13T
  • ROLLER 1995
  • DYNA PAK ROLLER
  • INTERNATIONAL TRUCK

• Attachments used

  Select ATLAS ROCK HAMMER KRUPP ROCK HAMMER SWEEPER BORER TRENCH ROLLER

  • ATLAS ROCK HAMMER
  • KRUPP ROCK HAMMER
  • SWEEPER
  • BORER
  • TRENCH ROLLER

• Document No.

• Client / Site

• Site representative

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personal

  Select Lou Camboni Bob Gifford Brian Prosser Glenn Ree Jake Veale Keiran Coleman Kelvin Walpole Mike Brown Peter Brown Tim Ditton Scott Westwood Kurt Sippel Daniel Cilia

  • Lou Camboni
  • Bob Gifford
  • Brian Prosser
  • Glenn Ree
  • Jake Veale
  • Keiran Coleman
  • Kelvin Walpole
  • Mike Brown
  • Peter Brown
  • Tim Ditton
  • Scott Westwood
  • Kurt Sippel
  • Daniel Cilia

JOB DESCRIPTION

• Take an image of area being assessed

  Media

• Can work commence without permits

  Yes

  No

  N/A

• If No, what permits are required?

OPERATOR COMPETENCE

• RISK SCORE IF OPERATOR IS INCOMPETENT

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Does Operator have required licence

  Yes

  No

  N/A

• Operator to have statement of competency from employer

  Yes

  No

  N/A

• Is Operator experienced with working with machine or one similar

  Yes

  No

  N/A

• Is Machine owners manual available for review

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

• RISK SCORE IF OPERATOR IS COMPETENT

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

ACCESS to and EGRESS from PLANT - SLIPS, TRIPS AND FALLS

• RISK OF SLIPS AND TRIPS

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• If Handrails are required are they in place?

  Yes

  No

  N/A

• If Steps are required are they in place?

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

• RISK SCORE IF HANDRAILS AND STEPS ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

MAINTENANCE

• RISK - MACHINE FAILURE, LOSS OF CONTROL OF PLANT

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Is the plant and equipment suitable for the tasks?

  Yes

  No

  N/A

• Have pre-start and post-start checks been carried out?

  Yes

  No

  N/A

• Is the plant safe to use?

  Yes

  No

  N/A

• If no,- Isolate, lockout, tag out, report and record

• Is service history available to site supervisor

  Yes

  No

  N/A

• If no, why?

• Plant regularly maintained as per manufacturers requirements?

  Yes

  No

  N/A

• If not, why?

• Chains and slings tested, tagged and up to date?

  Yes

  No

  N/A

• Will the use of specific plant and equipment be safe for the environment if used?

  Yes

  No

  N/A

• If no, refer to SWMS 6010 - Section 6

• RISK SCORE IF MACHINE IS WELL MAINTAINED

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

OTHER PLANT OPERATING IN VICINITY

• RISK - CONTACT / COLLISION WITH PERSON OR PLANT

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• RISK - Contact / Collision with Person or Plant

• Exclusion zone established

  Yes

  No

  N/A

• Flashing light and reversing beepers operational

  Yes

  No

  N/A

• Traffic management plan / traffic control to be employed

  Yes

  No

  N/A

• Moving plant policy / procedure to be employed

  Yes

  No

  N/A

• Additional hazards, which have not been shown above

• Plant operator is aware of machines or workers in the area

  Yes

  No

  N/A

• Spotter required?

  Yes

  No

  N/A

• Name of spotter

• RISK SCORE - if control measures are in place

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

COMMUNICATION

• RISK - Contact with other people / plant through inadequate communication

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Spotter & operators to communicate via 2 ways?

  Yes

  No

  N/A

• If no, list other means of communication.

• RISK SCORE AFTER CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

POOR GROUND - risk of machine rollover

• RISK - if machine rolls over

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Recent excavated areas not suitable for plant identified and communicated.

  Safe

  At Risk

  N/A

• No go zones established?

  Yes

  No

  N/A

• Ground conditions verified with plant operator

  Yes

  No

  N/A

• Roll over protection structure required?

  Yes

  No

  N/A

• Steep slopes and soft ground identified?

  Yes

  No

  N/A

• RISK SCORE IF CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

CONTACT WITH OVERHEAD POWER

• RISK - ELECTRICUTION

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• SAFE DISTANCES FROM LIVE OVERHEAD POWER
  3 metres fro 132 KVa,
  6metres from 132 to 330 KVa,
  8metres from over 330 KVa

Safe distances from live overhead power.

• Is machine operating within legal distances of overhead power line?

  Yes

  No

  N/A

• De-energisation of power lines required?

  Yes

  No

  N/A

• Plant operator is aware of machines or workers in the area

  Yes

  No

  N/A

• Spotter required?

  Yes

  No

  N/A

• Name of spotter

• Has Signage been installed alerting operators of the location of power lines?

  Yes

  No

  N/A

• Tiger tails installed?

  Yes

  No

  N/A

• Identify on site and on plan (for inductions) the location of services

  Yes

  No

  N/A

• Other

• RISK SCORE AFTER CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

DAMAGE TO UNDERGROUND SERVICES: Gas, Electrical, Water, Drainage.

• RISK - Electrocution - Fire - Explosion

• RISK SCORE if operator/machine was to come in contact with underground services

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Have dial before you dig plans been reviewed

  Yes

  No

  N/A

• Investigate and review any Work as Executed Drawings for services in the area

  Yes

  No

  N/A

• Engage a service locator to determine the location of services

  Yes

  No

  N/A

• Hand excavate areas to safely confirm location of services

  Yes

  No

  N/A

• Investigate and review any Work as Executed Drawings for services in the work area?

  Yes

  No

  N/A

• Identify on site and on plan (for inductions) the location of services

  Yes

  No

  N/A

• Other

• RISK SCORE AFTER CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

HAZARD RISK SCORE 1

• 

• RISK SCORE 1: Before SWMS have been chosen, select a Risk Score in reference to Risk Matrix table

  Select 5E 5D 5C 5B 5A 4E 4D 4C 4B 4A 3E 3D 3C 3B 3A 2E 2D 2C 2B 2A 1E 1D 1C 1B 1A

  • 5E
  • 5D
  • 5C
  • 5B
  • 5A
  • 4E
  • 4D
  • 4C
  • 4B
  • 4A
  • 3E
  • 3D
  • 3C
  • 3B
  • 3A
  • 2E
  • 2D
  • 2C
  • 2B
  • 2A
  • 1E
  • 1D
  • 1C
  • 1B
  • 1A

EXCESSIVE NOISE LEVELS DURING OPERATION

• RISK - Hearing damage, Disturbance to neighbours

• RISK SCORE IF NOISE IS EXCESSIVE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Plant fitted with mufflers?

  Yes

  No

  N/A

• Limited times of operation to be inforced

  Yes

  No

  N/A

• PPE Hearing protection to be worn

  Yes

  No

  N/A

• RISK SCORE AFTER CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

UNCONTROLLED MOVEMENT OF PLANT

• RISK - Crushing, Collision

• RISK SCORE IF LOSS OF CONTROL OF MACHINE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Roll over protective structures required

  Yes

  No

  N/A

• Steep slopes and soft ground identified

  Yes

  No

  N/A

• Plant not to exceed SWL

  Yes

  No

  N/A

• Safety switches and hand brake in in good working order?

  Yes

  No

  N/A

• Service history and requirements to be communicated within safe work method statement

  Yes

  No

  N/A

• SWMS - service history

• RISK SCORE IF CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

PLANT/EQUIPMENT CAPACITY/SUITABILITY FOR ACTIVITY

• RISK- Inadequate capacity, Inadequate reach, Machine failure.

• RISK SCORE IF MACHINE NOT SUITABLE FOR TASK

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Confirm weights prior to commencement

  Yes

  No

  N/A

• Confirm operating conditions prior to commencement

  Yes

  No

  N/A

• Confirm machines specifications and capabilities prior to commencement

  Yes

  No

  N/A

• RISK SCORE AFTER CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

POOR WEATHER CONDITIONS TO ALLOW FOR SAFE USE OF PLANT

• RISK- Roll over, Poor visibility, Electricution in wet weather

• RISK SCORE IF WEATHER IS UNSUITABLE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Weather has been assessed

  Safe

  At Risk

  N/A

• List control measure

• Visibility, Windy, Hot, Wet Weather. If work conditions deemed unsafe all works to cease until weather improves

  Yes

  No

  N/A

• RISK SCORE AFTER CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

MODIFICATIONS TO PLANT/EQUIPMENT

• RISK - Unapproved and in engineered modifications likely to fail

• RISK IF MODIFICATIONS ARE NOT APPROVED?

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Plant is not to be modified

  Yes

  No

  N/A

• Engineers certificate to be provided prior to commencement

  Yes

  No

  N/A

• Image of modification

  Media

• RISK SCORE IF APPROVED

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

PLANT OR EQUIPMENT FAILURE

• RISK - Explosion - Fire - Loss of Load

• RISK OF EXPLOSION - FIRE - LOSS OF LOAD if plant fails

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Service history of machine to be reviewed

  Yes

  No

  N/A

• Pre-start checks to be undertaken

  Yes

  No

  N/A

• SWMS required for refuelling on site

  Yes

  No

  N/A

• SWMS - Refuelling on site

• Plant regularly maintained so as lifting equipment is in good order

  Yes

  No

  N/A

• Chains and Slings tested and Tagged

  Yes

  No

  N/A

• Plant not to exceed SWL

  Yes

  No

  N/A

• Machine owners manual to be available for review

  Yes

  No

  N/A

• RISK SCORE IF CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

UNREGISTERED PLANT

• RISK - Safety Checks by Relevant Authorities have been carried out

• RISK SCORE IF SAFETY CHECKS ARE NOT CARRIED OUT

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• All statutory permits to be supplied to Principle Contractor

  Yes

  No

  N/A

• All WHS testing/maintenance logs supplied to the Principle Contractor

  Yes

  No

  N/A

• RISK SCORE IF PLANT IS WELL MAINTAINED

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

UNAUTHORISED ACCESS/USE OF PLANT

• RISK - Misuse - Theft - Vandalism

• RISK SCORE IF PLANT IS TAMPERED WITH

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Keys to be removed when not in use

  Yes

  No

  N/A

• Cabin doors to be locked

  Yes

  No

  N/A

• Pre-start checks to be undertaken

  Yes

  No

  N/A

• RISK SCORE IF CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

ADDITIONAL HAZARDS

• List additional Hazards

• RISK HAZARD SCORE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

• Image of Hazard

  Media

• Control Measures for Hazard

• RISK SCORE AFTER CONTROL MEASURES ARE IN PLACE

• High risk to Personnel/Environment - Loss of Life-Permanent Injury - Catastrophic Environmental Disaster

• High risk to Personnel/Environment - Serious Medical Treatment Injury - Serious Environmental Issue

• Medium Risk to Personnel/Environment - Medical Treatment Injury - Mid Level Environmental Breach

• Medium Risk to Personnel/Environment - 1st Aid Treatment Injury - Low Level Environmental Breach

• Low Risk to Personnel/Environment - Incident 1st Aid Treatment Injury - Low Risk to Environment

• Low Risk to Personnel/Environment - Incident no Injury - No Risk to Environment

SAFE WORK METHOD STATEMENTS

• SWMS - Site assessment and set up

• SWMS - Re-fuelling on Site

• SWMS - pre-start checks

• SWMS 7 - Operation of Excavator

• SWMS - Connection of attachments and appliances

• SWMS - Excavations greater that 3 metres in depth

• SWMS - Excavation on steep and slippery slopes

• SWMS - Loading, unloading and transportation of excavator to and from site

• SWMS - Loading of Materials into Trucks using an Excavator

• SWMS 14 - Demolishing by hand

• SWMS 14- Demolishing using an Excavator

• SWMS - De-watering of Excavation

• SWMS - Excavator using Jackhammer/Rock Breaker attachment

• SWMS - Spotter for Excavator

• SWMS - Excavation and Trenching

• SWMS - Isolate, lockout, tag and test

• SWMS - Removal of Trees, Stumps

• SWMS - Erecting and using Mobile scaffolds

• SWMS 5 - Working at heights

• SWMS - Dismantling mobile scaffolds

• SWMS - Using portable ladders

• SWMS 12 - Working with elevating work platforms

HAZARD RISK SCORE 2

• Have control measures been applied using SWMS?

• RISK SCORE 2: After SWMS have been chosen, select Risk Score in reference to Risk Matrix table.

  Select 5E 5D 5C 5B 5A 4E 4D 4C 4B 4A 3E 3D 3C 3B 3A 2E 2D 2C 2B 2A 1E 1D 1C 1B 1A

  • 5E
  • 5D
  • 5C
  • 5B
  • 5A
  • 4E
  • 4D
  • 4C
  • 4B
  • 4A
  • 3E
  • 3D
  • 3C
  • 3B
  • 3A
  • 2E
  • 2D
  • 2C
  • 2B
  • 2A
  • 1E
  • 1D
  • 1C
  • 1B
  • 1A

IF HAZARD RISK HIGH, REDO CONTROL MEASURES

• Is hazard risk score low?

  Yes

  No

  N/A

• Can work commence without changing the control measure?

  Yes

  No

  N/A

RISK ASSESSMENT CARRIED OUT BY

• Name

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• Name

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• Name

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• Name

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• Name

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• Name

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