Risk Assessment and Method Statement

• Site conducted

  Select

• This Risk Assessment is to be used in conjunction the departments generic risk assessments.

• RAMS Conducted on

  Date

• This document will assist you in completing the Risk Assessment. Please take a few minutes to complete all elements within this assessment. Once complete ensure you sign off the document and also include any other Team Members who are involved in the task/activity. Once complete please forward to your Supervisor / Manager. Thank you for your co-operation.

• Machine Model & Serial Number

• Site location

• Risk Assessment & Method Statement carried out by

• Please provide a job description and step by step of the work you are going to carry out to support this Risk Assessment

• Who is the point of contact on site and how is contact established?

• Did you have a formal induction covering the emergency arrangements and site HSE procedures or have been made aware of these?

  Yes

  No

  N/A

• Ask your site contact what the emergency arrangements and site HSE procedures are.

• Does the site require you to have a permit to work? If yes, state type of permit and retain a copy with your documents.

  Yes

  No

• What type of permit is required?

• Evaluate the ground conditions and site conditions and familiarise yourself with the machine Operations Manual and any other relevant information

• If the equipment has a pre-operation inspection, please complete this.

• 

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify Hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Do you wish to select additional hazards?

  Yes

  No

• Identify hazard

  Select Access and Egress Plant/Vehicle/Material Movement Confined/Restricted Space Entry Noise Vibration Chemical substances Poor Weather conditions Poor Lighting Manual Handling Airborne Particles Working at Height Unprotected Edges Fragile Surfaces Falling Objects Overhead Obstructions Mobile Lifting and/or Slinging Entanglement / Crushing / Impact Fire Blasting/ Explosion Hot Work / Weld Grind Climbing LPG / Oxy / Propane Combustible Materials Repetition Oxygen Enrichment/ Depletion Electrical Tracking Machine Stored energy / Release of potential energy Slips, Trips and Falls Flying Particles Contact with Sharp Edges Ground conditions Overhead powerlines Other workers in vicinity Fatigue Route of travel with part or machine Positioning and terrain on a third party site and/or Terex location Other

  • Access and Egress
  • Plant/Vehicle/Material Movement
  • Confined/Restricted Space Entry
  • Noise
  • Vibration
  • Chemical substances
  • Poor Weather conditions
  • Poor Lighting
  • Manual Handling
  • Airborne Particles
  • Working at Height
  • Unprotected Edges
  • Fragile Surfaces
  • Falling Objects
  • Overhead Obstructions
  • Mobile Lifting and/or Slinging
  • Entanglement / Crushing / Impact
  • Fire
  • Blasting/ Explosion
  • Hot Work / Weld Grind
  • Climbing
  • LPG / Oxy / Propane
  • Combustible Materials
  • Repetition
  • Oxygen Enrichment/ Depletion
  • Electrical
  • Tracking Machine
  • Stored energy / Release of potential energy
  • Slips, Trips and Falls
  • Flying Particles
  • Contact with Sharp Edges
  • Ground conditions
  • Overhead powerlines
  • Other workers in vicinity
  • Fatigue
  • Route of travel with part or machine
  • Positioning and terrain on a third party site and/or Terex location
  • Other

• Risk Rating Result

  1-2 No action

  3- 6 Monitor

  8-12 Action

  15 - 16 Urgent action

  20-25 Stop

• Please state countermeasures

• Are the weather and ground conditions suitable to complete the job? (e.g. is the area free of any manholes, potholes or visible underground services that could cause a risk).

  Yes

  No

  N/A

• Are you aware of the site procedures for traffic control and pedestrian traffic?

  Yes

  No

  N/A

• Are there roadways, potential traffic and/or people in the direct area? If yes, could the machine be moved to a safe location, roadway be closed and/or barrier used?

  Yes

  No

  N/A

• Is there suitable space to work around the machine removing any potential Line of Fire exposures?

  Yes

  No

  N/A

• Will I be working alone? Has approval from your supervisor been approved? If yes, outline agreed communication channel and who with.

  Yes

  No

  N/A

• If yes, outline agreed communication channel and who with.

• I have performed pre-use checks and confirmed calibration/inspection dates of all tooling and equipment required to complete the task.

  Yes

  No

  N/A

• Contamination prevention during service - Exterior surface of components shall be kept clean. Cap hoses and plug ports as soon as they are opened. Spill kits and drain trays are available. Contamination prevention during installation - All hoses and fittings shall remain capped until immediately prior to installation. New components such as seals and filters should not be removed from their packaging until they are going to be installed.

  Yes

  No

  N/A

WORKING AT HEIGHT RISK DEFINITION

• Very Low Risk
  If either point is true:
  1. Working from on and inside confines of onboard maintenance platform.
  2. Working from mobile engineered work platform (i.e. not a ladder) which has been pre-use checked and has been inspected in the last six months.
  Consider Access and Egress points during risk assessment

• Low Risk
  If all points are true:
  1. Does not meet very low risk definition
  2. No side railing (equivalent of handrails) or other onboard platform devices are available to prevent falling
  3. Working from any height above ground level but typically from top of tracks with stable footing
  4. Able to maintain three points of contact with structure. Hands are free (not carrying tools)
  5. Working at height does not exceed 3mins
  Assess the risk, use control measures where appropriate

• Medium Risk
  If all points are true:
  1. Does not meet very low or low risk definition
  2. Not able to maintain three points of contact
  3. Working at height for a period greater than 3 minutes or working in awkward position
  4. Using a ladder or similar to climb to work position
  5. Have a TM present who can rescue
  Assess the risk, use control measures where appropriate and record in the RAMS
  Use work restraint safety harness
  Have a rescue plan

• High Risk
  If all points are true:
  1. Does meet very low or low or medium risk definition
  Do not attempt - job pause

• Will I be working at height? If yes, list equipment, controls used, rescue plans, rescuer etc.

  Yes

  No

• What is my risk level

  Very low risk

  Low risk

  Medium risk

  High risk - job pause

• Only work at height equipment that has an up to date 6 month certified inspection and passes a pre-use inspection should be used. if your risk level does not require safety equipment select N/A

• Has the equipment been pre-use inspected and has a 6 month certified inspection? Record equipment used below

  Yes

  No

  N/A

• Outline what medium risk task requires working at height

• 4 point harness

  Yes

  No

  N/A

• Lanyards

  Yes

  No

  N/A

• Webslings

  Yes

  No

  N/A

• Anchor points

  Yes

  No

  N/A

• Rescue equipment

  Yes

  No

  N/A

• Describe the work at height rescue plan

• Who is the first aid trained rescuer

• Will i be working with or in the vicinity of rigging? If yes, can I stand clear? If performing Rigging have I completed a Rigging Plan?

  Yes

  No

• Will I be required to manually handle anything that requires lifting equipment or a second person?

  Yes

  No

• Will the task involve the use of a forklift, telehandler, excavator or other equipment? If yes, is it in good condition and the operator is trained?

  Yes

  No

• Will I be working in a confined or restricted space? If yes, 'Pause the Job' and seek advice.

  Yes

  No

• Will I be working with another person(s)? If yes, is there a work plan and an agreed three way communication procedure. If working with person(s) under the age of 18 take into account lack of experience and knowledge.

  Yes

  No

  N/A

• Will I be performing a task that involves hazardous energy(s)? If yes, identify the hazardous energy(s), system(s) being worked on, list control measures and how you will verify the control measures are effective.

  Yes

  No

• Gravity

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• Pressure

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• Motion

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• Electrical

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• Temperature

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• Radiation

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• Chemical & Biological

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• Physical & Mental

  Yes

  No

• Risk Level

  High

  Medium

  Low

• How will I control and verify?

• What are the specific steps (including barriers and communication) we will use when re-energizing?

• What are the specific triggers to Pause this Job and re-evaluate?

• Do I have: The correct PPE for the job and is it in good condition?

  Yes

  No

  N/A

• Risk Assessment Complete?

  Yes

  No

By signing this:

• I understand the nature of the work to be carried out, the risks and hazards involved and the control measures required.

• Only plant and equipment specified in this document will be worked on and no attempt will be made by me or anyone under my control to use or work on any other plant/equipment.

• I have assessed the risks associated with the site, the environment and the task that I am required to complete.

• I am able to follow the Terex Life Saving Behaviours.

• I feel confident that I perform the task safely and can ask for assistance if required.

• I will advise the customer/site contact and/or my supervisor of anything I consider to be unsafe.

• I am empowered to 'Pause the Job' and contact my supervisor if a "Job Pause" is required.

• All site notices, rules and instructions will be observed and complied with in full.

• Engineer/Assessor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Are there any other Team Members / Customer representatives / Dealer representatives / Contractor representatives/ Suppliers or Visitors present and/or involved in the task?

  Yes

  No

  N/A

• Please ensure all those involved have read, understood and signed above or below.

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

• Additional Team Member / Customer / Dealer / Contractor / Supplier / Visitor Signature:

  Sign

Notifications