Site Specific Risk Assessment

• Job Title

• Client / Site

• Document No.

• Location
  Address

• Conducted on

  Date

• Prepared by

  Sign

• Personnel

General

• Job Category

  Select New Installation Repair Other

  • New Installation
  • Repair
  • Other

• Job Type

  Select Light Powerpoint Fan AC Hot water Sensor Switchboard Circuit Other

  • Light
  • Powerpoint
  • Fan
  • AC
  • Hot water
  • Sensor
  • Switchboard
  • Circuit
  • Other

• Description

Hazards

• Powered Tools

• Falls

• Excavation

• Falling objects

• Moving plant

• Noise

• Manual handling

• Access / Egress

• Confined spaces

• Asbestos

• Working in trenches

• Live parts

• Dust

• Lone workers

• Scaffolding

• UV Radiation

• Ladders

• Other

• Other hazard:

SWMS

• Working on or near Exposed Energized Electrical Equipment

• Working Near Overhead Powerlines

• Heights

• Plant

• Excavation and Trenching

• Asbestos

• Confined spaces

• Hazardous substances

• Demolition

• Working on or near a road

Procedures

• Live testing

• Noise management

• Plant and Equipment

• PPE Management

• Risk Management and Hazard Intervention

• Visual Safety Examination Inspection

• Working in the sun

• Ladders

• Electrical Safety (general)

• Inspection of Safety Equipment

• Isolation Safety Tag and Lockout

• Inspection of Test Instruments

• Testing and Tagging

• Testing of Electrical Equipment & Installation

• Accessing a Pit or Pillar

• CCICR (ceiling, crawling & conductive roofs)

• Hazardous Substances Management

• Housekeeping

• Manual Handling

• Work on Electrical Equipment

• Working in the Vicinity of Exposed Live Parts

• Excavation and Trenching

• Safe Working with Asbestos

• Heights

• Heights Rescue

• Emergency Preparedness

Licences and Risks

• Competency Records / Licences

  Select electrical licence white card or equivalent scaffold > 3m erection licence EWP / Boom >11m lift licence other

  • electrical licence
  • white card or equivalent
  • scaffold > 3m erection licence
  • EWP / Boom >11m lift licence
  • other

• High Risk Plant / Equipment being used

  Select EWP / Boom Lift >11m Scaffold Scissor Lift Forklift EWP Boom Lift <11m Excavator Hiab / Crane Other

  • EWP / Boom Lift >11m
  • Scaffold
  • Scissor Lift
  • Forklift
  • EWP Boom Lift <11m
  • Excavator
  • Hiab / Crane
  • Other

• Other:

Risk Assessment

Task

• Task details

• Hazards and Risks

• Initial Risk Level

  Low

  Controlled

  High

• Controls undertaken to minimise risk:

• Residual Risk Level

  Low

  Controlled

  High

• Risk Likelihood Matrix

  

• Risk Decision Tree

  

• If the residual risk is High or Catastrophic, permission must be sought by High Level Management for work to proceed.

• Is the residual risk High or Catastrophic?

  Yes

  No

• You must contact High Level Management before continuing.

Certification

• I certify that the above control measures have been implemented and deemed the site to be safe:

  Sign

• Additional workers:

  Sign

• Additional workers:

  Sign