Risk Assessments - Libertyville

• Document No.

• Risk Assessment Equipment/Area/Task

• Conducted on

  Date

• Lead Assessor

• Other Assessors

Safety Declaration & Action Plan

• Safety Declaration

  Acceptable (activity may continue without corrective action plan)

  Continue activity (activity may continue with action plan)

  Prohibition (activity may not continue until corrective actions taken)

• Managers' Signature

  Sign

RPN

• Likelihood of Occurence

  Select 0.1 = Almost Impossible 0.5 = Highly Unlikely 1 = Unlikely but could occur 2 = Possible but unusual 5 = Even chance but could happen 8 = Probable 10 = Likely (to be expected) 15 = Certain (No doubt)

  • 0.1 = Almost Impossible
  • 0.5 = Highly Unlikely
  • 1 = Unlikely but could occur
  • 2 = Possible but unusual
  • 5 = Even chance but could happen
  • 8 = Probable
  • 10 = Likely (to be expected)
  • 15 = Certain (No doubt)

• Degree of Possible Harm

  Select 0.1 = Scratch or bruise or temporary illness 0.5 = Laceration or mild ill health effect 1 = Break of minor bone 2 = Break of major bone or major temporary illness 4 = Loss of a limb or an eye and permanent illness 8 = Loss of 2 limbs / eyes or serious permanent illness 15 = Fatality

  • 0.1 = Scratch or bruise or temporary illness
  • 0.5 = Laceration or mild ill health effect
  • 1 = Break of minor bone
  • 2 = Break of major bone or major temporary illness
  • 4 = Loss of a limb or an eye and permanent illness
  • 8 = Loss of 2 limbs / eyes or serious permanent illness
  • 15 = Fatality

• Number of People Exposed

  Select 1 = 1 to 2 Persons 2 = 3 to 7 Persons 4 = 8 to 15 Persons 8 = 16 to 50 Persons 12 = More than 50 Persons

  • 1 = 1 to 2 Persons
  • 2 = 3 to 7 Persons
  • 4 = 8 to 15 Persons
  • 8 = 16 to 50 Persons
  • 12 = More than 50 Persons

• Frequency of Exposure

  Select 0.1 = Infrequently 0.2 = About once a year 1 = Around once per month 2 = Every day / shift 4 = Around once an hour (8-12 times per shift) 5 = Constantly (Always present)

  • 0.1 = Infrequently
  • 0.2 = About once a year
  • 1 = Around once per month
  • 2 = Every day / shift
  • 4 = Around once an hour (8-12 times per shift)
  • 5 = Constantly (Always present)

• Calculate RPN Number:

Tasks

• List all regular operation tasks associated with Equipment/Area

• Personal Protection advised for this Work?

  Yes

  No

  N/A

Hazards

Hazard 1

• Access/Egress (obstructions/congestion)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

• Yes

  No

  N/A

Hazard 2

• Slips, Trips, Falls

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 3

• Heights (including steps, ladders, lifts, etc.)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 4

• Lone Work

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 5

• Confined Spaces / Hot Work

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 6

• Contact with Moving Equipment (entanglement, crush, etc.)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 7

• Hit by flying or falling objects (from cranes, ejected from machines)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 8

• Hit by moving objects

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 9

• Lifting Equipment

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 10

• Electricity (including portable appliances)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 11

• Flammable Materials / Hazardous Substances

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 12

• Burns

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 13

• Compressed Gas / Cryogenics (storage & use)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 14

• Pinch Points

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 15

• Cuts

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 16

• Noise Exposure

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 17

• Transport (forklifts, vehicles, etc.)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 18

• Storage (racks, shelves, etc.)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 19

• Weather (hot, cold, storms, etc.)

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 20

• Contact with a fixed/stationary object

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 21

• Pressure Systems

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Risk Level

  High

  Medium

  Low

• Corrective Actions & who is responsible:

• Completion Date

  Date

Hazard 22

• Other Hazards

• How may harm occur?

• Add media

  Media

• Existing Control Measures

• Risk Level

  High

  Medium

  Low

• CA Required?

  Yes

  No

• Risk Level

  High

  Medium

  Low

• Corrective Actions & who is responsible:

• Completion Date

  Date

Ergonomics

• Manual Handling

• Load Weight and lift frequency

  Purple

  Red

  Amber

  Green

• Hand Distance from lower back

  Purple

  Red

  Amber

  Green

• Vertical lift region

  Purple

  Red

  Amber

  Green

• Trunk Twisting / Sideways bending

  Purple

  Red

  Amber

  Green

• Postural Constraints

  Purple

  Red

  Amber

  Green

• Grip of Load

  Purple

  Red

  Amber

  Green

• Floor Surface

  Purple

  Red

  Amber

  Green

• Other environmental factors

  Purple

  Red

  Amber

  Green

• Load Weight & Carry Frequency

  Purple

  Red

  Amber

  Green

• Trunk twisting / sideways bending

  Purple

  Red

  Amber

  Green

• Postural Constraints

  Purple

  Red

  Amber

  Green

• Grip of Load

  Purple

  Red

  Amber

  Green

• Floor Surface

  Purple

  Red

  Amber

  Green

• Other environmental factors

  Purple

  Red

  Amber

  Green

• Carry Distance (carrying only)

  Purple

  Red

  Amber

  Green

• Obstacles en route (carrying only)

  Purple

  Red

  Amber

  Green

• CA Required?

  Yes

  No

• Corrective Actions & who is responsible:

• Completion Date

  Date

• Participants to sign

  Sign

• Participants to sign

  Sign

• Participants to sign

  Sign

• Participants to sign

  Sign