Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

Hazards

Hazard Identification:

  • Entanglement

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add Media if required

  • Risk is not Okay

  • Add media if required

  • Cutting,stabbing or Puncturing

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Striking

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Shearing/Burning/Friction

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • High Pressure (Fluid/Gases)

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Electrical

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Gases or Vapours

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Slips/Trips/Falls

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Manual Handling

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Extreme of Temperature

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Light

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Noise

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

  • Any other Hazard not listed

  • Select who may be at risk.

  • Select the severity

  • Select the Likelihood of the Injury Occurring

  • Select the Risk Rating ( Severity X Likelihood

  • Risk is Okay

  • Add media if required

  • Risk is not Okay

  • Add media if required

Existing Controls

Hazard Selection

    Hazard
  • Contributing Factors

  • Existing Contols

  • Risk Status

Risk Control Action Plan

Hazard Rectification

    Hazard
  • Further Controls/Actions required

  • Who is responsible for actions?

  • Date by when actions should be completed

  • Date when actions are completed

Assessor Detail:

  • Assessed by:

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