Site Specific Risk Assessment

• Location
  Address

• Principal Contractor/Builder

• Date on Site

  Date
• Site Address
  Address

• Supervisor

• Job Description

• Photo of Job Site- Emergency Meeting Place (or site point of entry)

  Media

IDENTIFY SITE SPECIFIC HAZARDS- Potential On Site Hazards

• Risk of falls greater than 2 meters

  Yes

  No

  N/A

• Likely to involve disturbing asbestos

  Yes

  No

  N/A

• Manual handling

  Yes

  No

  N/A

• Work in confined spaces

  Yes

  No

  N/A

• Electrical (exposed live conductors)

  Yes

  No

  N/A

• Moving equipment

  Yes

  No

  N/A

• Work on or near energised electrical services

  Yes

  No

  N/A

• Dehydration

  Yes

  No

  N/A

• Weather

  Yes

  No

  N/A

• Likely to involve disturbing asbestos

  Yes

  No

  N/A

• Underground services

  Yes

  No

  N/A

• Pedestrians

  Yes

  No

  N/A

• Work in confined spaces

  Yes

  No

  N/A

• Chemical (inhaling, swallowing, touching)

  Yes

  No

  N/A

• Other

• Other

DETERMINE WHAT PLANT, EQUIPMENT & PPE IS LIKELY TO BE USED

• 6" Fibreglass Step Ladder

  Yes

  No

  N/A

• 8" Fibreglass Step Ladder

  Yes

  No

  N/A

• Fibreglass Extension Ladder

  Yes

  No

  N/A

• Excavator

  Yes

  No

  N/A

• Post Hole digger

  Yes

  No

  N/A

• Grinder

  Yes

  No

  N/A

• Percussion/Hammer drill

  Yes

  No

  N/A

• Demolition/Jack Hammer

  Yes

  No

  N/A

• Other

• Other

Select the PPE likely to be used

• Respiratory Protective Device

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Harness / Lifeline

  Yes

  No

  N/A

• Safety Helmet/Hard Hat

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Communications Equipment

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• Torch/Lighting

  Yes

  No

  N/A

• Safety Boots / Gum Boots

  Yes

  No

  N/A

• Fire Fighting Equipment

  Yes

  No

  N/A

• Overalls / Disposable Overalls

  Yes

  No

  N/A

• Mechanical Ventilation Device

  Yes

  No

  N/A

• Respiratory Protective Device

  Yes

  No

  N/A

• Barricading and Signage

  Yes

  No

  N/A

• Lock Out Tag Out Kit

  Yes

  No

  N/A

• Arc Rated clothing

  Yes

  No

  N/A

• Out of service tags

  Yes

  No

  N/A

• LV Rescue Kit

  Yes

  No

  N/A

SWMS THAT APPLY TO THE WORK (Safe Work Method statements)

• SWMS C100- Accessing and Set Up of Work Site

  Yes

  No

  N/A

• SWMS C101- Safe Use of Ladders

  Yes

  No

  N/A

• SWMS C102- Erecting, Altering & Dismantling Scaffold

  Yes

  No

  N/A

• SWMS C103- Safe Use of Elevated Work Platform

  Yes

  No

  N/A

• SWMS C104- Restraint & Fall Arrest Systems

  Yes

  No

  N/A

• SWMS C105- Excavation

  Yes

  No

  N/A

• SWMS 106- Confined Space Work

  Yes

  No

  N/A

• SWMS C108- Working With Asbestos

  Yes

  No

  N/A

• SWMS C109- Hazardous Areas

  Yes

  No

  N/A

• SWMS E100- Low Voltage Isolation

  Yes

  No

  N/A

• SWMS E101- Energise And Commission

  Yes

  No

  N/A

• SWMS E102- Testing For DeEnergised & Energised

  Yes

  No

  N/A

• SWMS E104- Data & Electrical cable installation

  Yes

  No

  N/A

• Other

• undefined

STATE THE SITE-SPECIFIC CONTROLS (not covered by either the SWMS/SWP)

• List the controls mechanisms that will be put in place for the hazards above that are not already controlled by the SWMS or SWP: Note: Any residual risk that is Medium or above requires a Supervisor or a Manger to sign off

  Select

• 1.

• Select the level of risk that personnel may be exposed to after controls are in place

  Select

• 2.

• Select the level of risk that personnel may be exposed to after controls are in place

  Select

• 3.

• Select the level of risk that personnel may be exposed to after controls are in place

  Select

WORKER AND CONTRACTOR SIGN OFF

• I have read and understood the Safe Work Method Statement and agree to perform the work according to the requirements of this HRA and associated MSDS, Procedures, SWP, legislative requirements

  Select

• Employee Name

• Date

  Date