Title Page
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Organisation Unit
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Location
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Task
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Description of Activity
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Cost of Control Measures
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Does this need to added to the risk register?
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Issue number
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Purpose of new issue
- general review (2 years since last review)
- Due to an accident
- Due to change in process
- Risk assessment no longer suitable
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Add detailed description of review
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Assessment Date
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Review Date
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Assessor (name)
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Assisted by (names)
Personnel Involved
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Work Start Time
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Work Planned End Time
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Works Supervisor
Personnel carrying out work
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Operator name
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Role in the task
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Is the operator adequately trained?
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Has the operator had suitable health surveillance?
Emergency and Welfare Preparedness
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What is the location of the welfare facilities?
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Where is the evacuation muster point?
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Who is the first aider on site?
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Where is the location of the first aid box?
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Is a Permit to Work (PTW) required?
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What type of PTW is required?
Risk Assessment
- Add a Hazard
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Select your Hazard
- Confined Spaces
- Contact with electricity
- Contact with moving machinery parts
- Contact with moving object
- Contact with moving vehicles
- Contact with stationary object
- Contact with needle stick or open blade
- Contact with objects at height
- Contact with hazardous materials
- Contact with dusts
- Contact with biohazards
- Lifting objects using mechanical aids
- Lone working
- Moving heavy objects (manually)
- Repetitive movements
- Slippery or uneven surfaces
- Falling from height
- Working at night/ shift work
- Working with display screens
- Working with open flames/ hot work
- Working with deep water
- Working in low/ high temperatures
- Working with loud noises/ long term noise
- Other unlisted hazard
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What is the source of Hazard?
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Who is exposed?
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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What are the existing controls?
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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Use the Risk Matrix to determine the risk rating for this hazard
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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please first go and complete the risk assessment for COSHH/ handling hazardous materials and ensure you have a current safety data sheet available
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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please first complete the risk assessment for Manual handling
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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please first go and complete the risk assessment for using display screen equipment (DSE)
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Other Hazard
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
Method Statement
- Add steps to complete the task
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Task Stepdo another thing
Control Measures and Personal Protective Equipment Required
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Specialist Equipment, Plant Tools to be used
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Complete Crane Inspection https://public-library.safetyculture.io/products/crane-inspectionqD4xn?utm_source=public-library&utm_medium=share_link&utm_content=template_B768C5E6D3FB43D2864D43AE31FD28B9
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Has the crane Inspection been completed?
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Complete MEWP Inspection https://public-library.safetyculture.io/products/mewp-inspection-report-LHXPP?utm_source=public-library&utm_medium=share_link&utm_content=template_937d8287e6f140cba02635de06f5f72b
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Has the MEWP Inspection been completed?
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Complete Cherry Picker Inspection https://public-library.safetyculture.io/products/working-at-heights-inspection?utm_source=public-library&utm_medium=share_link&utm_content=template_88a90bddbe68430e993430ed54acea2c
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Has the Cherry Picker Inspection been completed?
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Are machinery protection devices (guards, interlocks) used as a control measure for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is there a specific system of work (e.g. SSW, JSA, Work at Height Permit) required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is Hearing Protection required for this task?
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Specify Type/ Grade
- EN352 Disposable ear plugs
- EN352 Reusable ear plugs
- EN352 Over ear defenders
- EN352 Communication Ear defenders
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Task / Hazard Controlled
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Is Eye Protection required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is Respiratory Protection required for this task?
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Specify Type/ Grade
- EN136 - face/dust mask
- EN136 - respirator - face fit required
- self contained breathing apparatus - training required
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Task / Hazard Controlled
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Is Hand Protection required for this task?
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Specify Type/ Grade
- EN388 Puncture resistant
- EN388 Cut resistant
- EN388 Impact resistant
- EN388 Abrasion resistant
- EN374 Chemical resistant
- EN407 Thermal (heat) resistant
- EN511 Thermal (cold) resistant
- EN388 Vibration resistant
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Task / Hazard Controlled
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Is protective coveralls/ clothing required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is Hi Vis Clothing required for this task?
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Specify Type/Grade
- EN471,2 Hi Vis Vest front fastening
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Task / Hazard Controlled
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Is safety footwear required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is there other personal protective equipment required for this task?
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Please specify
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Specify Type/ Grade
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Task / Hazard Controlled
Sign off
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Manager's Name & Signature
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This document must now be communicated with all relevant persons