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

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