Title Page

  • Organisation Unit

  • Location
  • Task

  • Description of Activity

  • Cost of Control Measures

  • Does this need to added to the risk register?

  • Issue number

  • Purpose of new issue

  • Add detailed description of review

  • Assessment Date

  • Review Date

  • Assessor (name)

  • Assisted by (names)

Personnel Involved

  • Work Start Time

  • Work Planned End Time

  • Works Supervisor

  • Personnel carrying out work
  • Operator name

  • Role in the task

  • Is the operator adequately trained?

  • Has the operator had suitable health surveillance?

Emergency and Welfare Preparedness

  • What is the location of the welfare facilities?
  • Where is the evacuation muster point?
  • Who is the first aider on site?

  • Where is the location of the first aid box?
  • Is a Permit to Work (PTW) required?

  • What type of PTW is required?

Risk Assessment

    Add a Hazard
  • Select your Hazard

  • What is the source of Hazard?

  • Who is exposed?

  • What is the type of injury that could occur?

  • What are the existing controls?

  • How much is the likelihood of occurrence of hazard

  • What could be the severity of Injury/ Disease

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • please first go and complete the risk assessment for COSHH/ handling hazardous materials and ensure you have a current safety data sheet available

  • Source of Hazard

  • Who is exposed

  • What is the type of injury that could occur?

  • Existing Controls

  • How much is the likelihood of occurrence of hazard

  • What could be the severity of Injury/ Disease

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • please first complete the risk assessment for Manual handling

  • Source of Hazard

  • Who is exposed

  • What is the type of injury that could occur?

  • Existing Controls

  • How much is the likelihood of occurrence of hazard

  • What could be the severity of Injury/ Disease

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • please first go and complete the risk assessment for using display screen equipment (DSE)

  • Source of Hazard

  • Who is exposed

  • What is the type of injury that could occur?

  • Existing Controls

  • How much is the likelihood of occurrence of hazard

  • What could be the severity of Injury/ Disease

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Other Hazard

  • Source of Hazard

  • Who is exposed

  • What is the type of injury that could occur?

  • Existing Controls

  • How much is the likelihood of occurrence of hazard

  • What could be the severity of Injury/ Disease

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

  • Use the Risk Matrix to determine the risk rating for this hazard

    Screenshot 2022-01-28 at 17.33.23.png
  • What is the risk rating for this hazard?

Method Statement

    Add steps to complete the task
  • Task Stepdo another thing

Control Measures and Personal Protective Equipment Required

  • Specialist Equipment, Plant Tools to be used

  • Complete Crane Inspection https://public-library.safetyculture.io/products/crane-inspectionqD4xn?utm_source=public-library&utm_medium=share_link&utm_content=template_B768C5E6D3FB43D2864D43AE31FD28B9

  • Has the crane Inspection been completed?

  • 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

  • Has the MEWP Inspection been completed?

  • 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

  • Has the Cherry Picker Inspection been completed?

  • Are machinery protection devices (guards, interlocks) used as a control measure for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is there a specific system of work (e.g. SSW, JSA, Work at Height Permit) required for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is Hearing Protection required for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is Eye Protection required for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is Respiratory Protection required for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is Hand Protection required for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is protective coveralls/ clothing required for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is Hi Vis Clothing required for this task?

  • Specify Type/Grade

  • Task / Hazard Controlled

  • Is safety footwear required for this task?

  • Specify Type/ Grade

  • Task / Hazard Controlled

  • Is there other personal protective equipment required for this task?

  • Please specify

  • Specify Type/ Grade

  • Task / Hazard Controlled

Sign off

  • Manager's Name & Signature

  • This document must now be communicated with all relevant persons

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.