Risk Assessment - Sample RVD - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Hazard risk rating (circle one – REFER TO RISK MATRIX BELOW)

  Drawing

• Consequence

  Insignificant (C1)

  Minor (C2)

  Moderate (C3)

  Major (C4)

  Catastrophic (C5)

• Probability

  Select Almost Certain (P5) Likely (P4) Possible (P3) Remotely Possible/Unlikely (P2) Practically Impossible/Rare (P1)

  • Almost Certain (P5)
  • Likely (P4)
  • Possible (P3)
  • Remotely Possible/Unlikely (P2)
  • Practically Impossible/Rare (P1)

• Risk rating

  Medium - M6

• Risk rating

  Low - L7

• Risk rating

  Low - L6

• Risk rating

  Low - L3

• Risk rating

  Low - L1

• Probability

  Select Almost Certain (P5) Likely (P4) Possible (P3) Remotely Possible/Unlikely (P2) Practically Impossible/Rare (P1)

  • Almost Certain (P5)
  • Likely (P4)
  • Possible (P3)
  • Remotely Possible/Unlikely (P2)
  • Practically Impossible/Rare (P1)

• Risk rating

  Medium - M8

• Risk rating

  Medium - M5

• Risk rating

  Low - L8

• Risk rating

  Low - L5

• Risk rating

  Low - L2

• Probability

  Select Almost Certain (P5) Likely (P4) Possible (P3) Remotely Possible/Unlikely (P2) Practically Impossible/Rare (P1)

  • Almost Certain (P5)
  • Likely (P4)
  • Possible (P3)
  • Remotely Possible/Unlikely (P2)
  • Practically Impossible/Rare (P1)

• Risk rating

  Medium - M9

• Risk rating

  Medium - M7

• Risk rating

  Medium - M4

• Risk rating

  Medium - M2

• Risk rating

  Low - L4

• Probability

  Select Almost Certain (P5) Likely (P4) Possible (P3) Remotely Possible/Unlikely (P2) Practically Impossible/Rare (P1)

  • Almost Certain (P5)
  • Likely (P4)
  • Possible (P3)
  • Remotely Possible/Unlikely (P2)
  • Practically Impossible/Rare (P1)

• Risk rating

  High - H7

• Risk rating

  High - H5

• Risk rating

  High - H3

• Risk rating

  Medium - M3

• Risk rating

  Medium - M1

• Probability

  Select Almost Certain (P5) Likely (P4) Possible (P3) Remotely Possible/Unlikely (P2) Practically Impossible/Rare (P1)

  • Almost Certain (P5)
  • Likely (P4)
  • Possible (P3)
  • Remotely Possible/Unlikely (P2)
  • Practically Impossible/Rare (P1)

• Risk rating

  High - H8

• Risk rating

  High - H6

• Risk rating

  High - H4

• Risk rating

  High - H2

• Risk rating

  High - H1

Unloading/Loading of Carriers

• Are the following Hazards Identifiable at the delivery point?

  Select Camber and or Slope Members of the public at Risk Slip and or Trip Hazards Uneven and or Tactile Surface

  • Camber and or Slope
  • Members of the public at Risk
  • Slip and or Trip Hazards
  • Uneven and or Tactile Surface

• Approximately how far (in meters) is the Unloading/Loading Point to the final Delivery Point?

• Does the driver have to handle carriers across a roadway and or crossing point to gain access to the final delivery point?

  YES

  NO

• Does the driver have to handle carriers Up and Down a Significant Incline?

  YES

  NO

• Does the nature of the delivery require Double Manning?

  YES

  NO

• What type of delivery has been agreed with the customer?

  Roll Off

  HandBall

  Combined

• Provide any additional information relevant to the final delivery point and or additional customer requirements

• Select the OVERALL Risk Rating by multiplying the Manoeuvring result with the Unloading/Loading result (1-6 LOW, 8-12 MEDIUM, 15-25 HIGH)

  LOW

  MEDIUM

  HIGH

Sign off

• Add signature

  Sign