Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • STEP ONE - Plant Information Questions

  • Add media

  • What is the plant used for?

  • How is the plant used?

  • Add media

  • Describe the layout of this machine in relation to surrounding machines or other potential risk (vehicles, weather exposure etc)

  • Does the plant need to be operated by:

  • Certificates / Qualifications Required?

  • Does operator have certificates / qualifications / training?

  • Is there a system of work for using the plant? (I.e Policies, Safe Operating Procedures, Maintenance Procedures) - if yes pls attach to this assessment.

  • Has the operator been trained in the SOP?

  • Is there any operation outside normal operating conditions?

  • Additional assessment information.
    Is there past experience with the plant operation that may assist on the assessment.
    Consider the effectiveness of existing controls, safe operating procedures, operator training, accidents, incidents, near misses, industry practice or relevant standards.
    (If so, attach copies)

  • STEP TWO - Hazard Identification

  • All the factors below must be taken into consideration for normal operation and during:
    - testing
    - inspection
    - maintenance
    - cleaning
    - repairing

  • Entanglement<br>Can anyone's hair, clothing, gloves, neck tie, jewellery, rags and other materials become entangled with moving parts of plant, or materials in motion?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Electrical<br>Can anyone be injured by electrical shock or burnt due to damaged or poorly maintained leads or switches, water near electrical equipment, working near or contact with live electrical conductors, lack if isolation procedures or the factors not mentions?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Cutting, Stabbing & Puncturing<br>Can anyone be cut, stabbed or punctured by coming in contact with moving plant or parts, sharp or flying objects, work pieces ejected or disintegrated or other factors not mentioned?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Burns<br>Can anyone be burnt due to contact with moving parts or surfaces of the plant, or material handled by the plant?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Explosion<br>Can an explosion of gas, vapours, liquids, dusts or other substances, triggered by plant operation, injure anyone?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Crushing<br>Can anyone be crushed due to:<br>- falling<br>- uncontrolled or unexpected movement of plant or its load<br>- lack of capacity to slow, stop or immobilise the plant <br>- the plant tipping or rolling over <br>- parts of plant collapsing<br>- being thrown off or under the plant <br>- being trapped between plant and materials or fixed structures

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Slipping, Tripping & Falling<br>Can anyone using the plant or in the vicinity of the plant, slip, trip or fall due to the working environment or other factors?<br>I.e poor housekeeping, slippery or uneven work surfaces or lack of guard rails.<br>

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Shearing<br>Can anyone's body parts be cut off between two parts of the plant, or between a part of the plant and a work piece or structure?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Striking<br>Can anyone be struck by moving objects due to plant or work pieces being ejected or disintegrated, mobility, uncontrolled or unexpected movement or other factors?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • High Pressure Fluid<br>Can anyone come into contact with fluids under high pressure, due to plant failure or misuse of the plant?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Temperature (Thermal Comfort) <br>Can anyone suffer ill health due to exposure to high or low temperatures?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Ergonomic<br>Can anyone be injured due to seating design, repetitive body movement or posture, excessive effort, poor workplace or plant design causing mental or physical stress, lack of consideration for human behaviour, poor lighting or other factors not mentioned?

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Atmospheric Conditions & / or Pollutants<br>Can anyone be injured or suffer ill health from exposure to chemicals, toxic gases or vapours, fumes, dusts, excessive noise, vibration, radiation or other factors not mentioned?<br><br>Noise Measurement........... dBA<br>

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • Hazardous Substance / Dangerous Goods<br>Are there any chemicals present within the process? If so, are they a Hazardous Substance or a Dangerous Good?<br><br>If yes, complete a CHEMICAL RISK ASSESSMENT FORM

  • Risk Identification

  • Current Risk Control

  • Risk Matrix Ready Reakoner

    no label
  • Likelihood

  • Consequence

  • Overall Risk Score

  • STEP THREE - Plant Control Strategy Actions
    (Proposed Short / Long Term Controls)

  • Add media

  • Person Responsible:

  • Date Implementation is to be completed

  • Person Responsible:

  • Date Implementation is to be completed

  • Person Responsible:

  • Date Implementation is to be completed

  • Person Responsible:

  • Date Implementation is to be completed

  • Person Responsible:

  • Date Implementation is to be completed

  • Person Responsible:

  • Date Implementation is to be completed

  • Person Responsible:

  • Date Implementation is to be completed

  • Date For Review:

  • Select date

  • Person Responsible:

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.