Title Page
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What is being assessed
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Affected work area:
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Location
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Conducted on
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Prepared by
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Assessed by:
Assessor
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Add signature
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Does the task involve accessing an elevated work area: Is this all of the time or some of the time? Elevated work area is any work area a worker can fall from or off whilst completing their duties
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
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Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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Does the task involve accessing an elevated work area for example : Roof, truck, truck and trailer, tank, walkways, silo and any other elevated work area?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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Truck?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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truck and trailer?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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What material is the elevated work area surface constructed: Steel, Wood, Concrete, Other Surfaces not mentioned?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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Can the elevated work area be affected by weather: Sun, Wind, Rain, Hail or Ice, State weather conditions in comments
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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Is the elevated work area surface: Steep, Slippery, Uneven (Trip hazards)?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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How high is the elevated work platform:
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(The higher the elevated work area, generally the higher the risk of a fall and injury or death unless high order safety measures are in placed and used.)
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Above 1.4mt
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Above 2mt
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Above 5mt
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Above 10mt
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Above 20mt
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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How is the elevated work area accessed or egressed, Ladders, Stairs, Steps, Mechanical lift, Other access mechanisms not mentioned?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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Can anyone be stuck by falling objects from the elevated work area: Tools, Equipment, Materials, Animals and or People?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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Can anyone working on the elevated work area, come into contact with electricity or electrical sources: Electrical conductors, Overload of electrical circuits, Damaged or poorly maintained electrical leads/cable, Damaged electrical switches, Lack of isolation procedures or Other factors not mentioned?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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What safety measures are already in place to prevent a fall: Guard rail, Safety mesh, Scaffolding,Caged Ladder, Elevated work platform,Fall arrest anchorage points, Catch platform, three metre clear zone and Other factors not ?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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Are the safety measures in good condition : Good working condition? Regularly inspected? Is it documented? Rated attachment points checked by a competent person?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
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What supervision has been provided for the employees working at height?
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Describe the findings, then complete the risk assessment process – Using the risk matrix tables above, list below the identified risks
Click +Add to begin
Assessment
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Comments
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Current risk rating<br>Use the Risk Matrix<br>
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Corrective action
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Residual risk rating<br>Use the Risk Matrix
