Title Page
-
Site conducted
-
Conducted on
-
Prepared by
-
Location
-
Job description
What equipment is being worked on?
Hazards identified
-
1. Electricity
-
What are your control measures?
-
2. Moving parts
-
What are your control measures?
-
3. Compressed air
-
What are your control measures?
-
4. Water/Fluids
-
What are your control measures?
-
5. Manual Handling
-
What are your control measures?
-
6. Restricted Access
-
What are your control measures?
-
7. Slips & Trips
-
What are your control measures?
-
8. High/Low temperature
-
What are your control measures?
-
9. Falling Objects
-
What are your control measures?
-
10. Lighting Levels
-
What are your control measures?
-
11. Stored Energy
-
What are your control measures?
-
12. Workplace Transport
-
What are your control measures?
-
13. Molten Material
-
What are your control measures?
-
14. Fumes/Gas
-
What are your control measures?
-
15. Chemicals
-
What are your control measures?
-
16. Dust
-
What are your control measures?
-
17. Weather Conditions
-
What are your control measures?
-
18. Working at Height
-
What are your control measures?
-
19. Other
-
What are your control measures?
Evaluation
Likelihood (1-5)
-
Never
-
Unlikely
-
Possible
-
Likely
-
Always
Severity (1-5)
-
Trivial
-
Minor Injury
-
>3 Day Injury
-
Major Injury
-
Fatality
Evaluation=Likelihood x Severity
-
Low 1-5
-
Medium 6-10
-
High 11-25