Audit

Plant Information

Plant Item

Plant Identification Details (Model/ Make/ Serial)

Plant Owner Name

Plant task description

Is the plant designed to perform the task?

Is the plant in good working condition and free of weeds and mud?

References

Risk Matrix Reference

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Hierarchy of Controls Reference

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Explosion/ Fire

Can anyone be injured by an explosion of gas, vapours, liquids, dusts or other substances, triggered by plant operation?

Hazard

Activity

Description of hazards identified

Photo of hazard (optional)

Persons at risk

Initial risk rating

Initial consequence

Initial likelihood

Initial risk rating

Residual risk rating

Residual consequence

Residual likelihood

Residual risk rating

Controls
Select control measures

Enter other control measures

Enter description of control measures

Electricity Contact

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

Hazard

Activity

Description of hazards identified

Photo of hazard (optional)

Persons at risk

Initial risk rating

Initial consequence

Initial likelihood

Initial risk rating

Residual risk rating

Residual consequence

Residual likelihood

Residual risk rating

Controls
Select control measures

Enter other control measures

Enter description of control measures

Cutting

Can anyone be cut, stabbed or punctured by coming in contact with moving plant or parts?

Hazard

Activity

Description of hazards identified

Photo of hazard (optional)

Persons at risk

Initial risk rating

Initial consequence

Initial likelihood

Initial risk rating

Residual risk rating

Residual consequence

Residual likelihood

Residual risk rating

Controls
Select control measures

Enter other control measures

Enter description of control measures

Entanglement

Can anyone’s hair, clothing, gloves, necktie, jewellery, rags and other materials become entangled with moving parts of plant, or materials in motion?

Hazard

Activity

Description of hazards identified

Photo of hazard (optional)

Persons at risk

Controls
Select control measures

Enter other control measures

Enter description of control measures

Initial risk rating

Initial consequence

Initial likelihood

Initial risk rating

Residual risk rating

Residual consequence

Residual likelihood

Residual risk rating

Crushing

Can anyone be crushed due to falling, uncontrolled or unexpected movement of plant or its load?

Hazard

Activity

Description of hazards identified

Photo of hazard (optional)

Persons at risk

Initial risk rating

Initial consequence

Initial likelihood

Initial risk rating

Controls
Select control measures

Enter other control measures

Enter description of control measures

Residual risk rating

Residual consequence

Residual likelihood

Residual risk rating

Completion

Recommendations

Signature