Title Page

  • Conducted on

  • Area/Department

  • Prepared by

  • plant risk assessed

Can the following items become ENTANGLED with moving parts of the plant, or materials in motion:

  • Hair, Jewellery, Rags, Gloves, clothing

  • Other materials – specify:

EMERGENCY STOP BUTTONS - can injury from interaction with the plant be caused by:

  • Lack of prominence of emergency stop Emergency stop not being fail safe

  • Emergency stop not red in colour

  • Stored energy being released slowly or at a sequent time

  • Lack of clarity of emergency stop markings

  • Restarting plant by resetting the emergency stop button

  • Other factors – specify:

Can anyone be CRUSHED due to:

  • Falling, uncontrolled or unexpected movement of plant

  • Lack of capacity to slow, stop or immobilize the plant

  • Falling, uncontrolled or unexpected movement of plant’s load

  • Under or trapped between plant and materials or fixed structure

  • Contact with moving parts during testing, inspection, maintenance, cleaning or repair

  • Tipping or rolling over Parts of plant collapsing

  • Being thrown off

  • Other factors – specify:

Can anyone be CUT, STABBED or PUNCTURED by coming in contact with:

  • Moving plant or parts

  • Sharp or flying objects

  • Work pieces disintegrated

  • Work pieces ejected

  • Other factors – specify: <br> <br>

SHEARING – Can anyone’s body parts be cut off between:

  • Two parts of the plant

  • A part of the plan and a work piece or structure

  • Other factors – specify:

Can anyone be injured by ELECTRICAL shock or burnt due to:

  • Damaged/poorly maintained leads or switch

  • Working near or contact with live electrical conductors

  • Water near electrical equipment Lack of isolation procedures

  • Other factors – specify:

Can anyone be injured by an EXPLOSION of the following items triggered by plant operation

  • Gas Dust

  • Vapours Liquids

  • Other factors – specify:

FRICTION - Can anyone be burnt due to:

  • Contact with moving parts or surfaces of the plant

  • Material handled by the plant

  • Other factors – specify:

Can anyone be STRUCK by moving objects due to:

  • Plant or work pieces being ejected or disintegrated Mobility

  • Uncontrolled or unexpected plant movement

  • Other factors – specify:

Can anyone using the plant or in the vicinity of the plant, SLIP, TRIP or FALL due to:

  • The working environment Uneven work surfaces Lack of guardrails

  • Uneven work surfaces Lack of guardrails

  • Slippery work surfaces

  • Poor housekeeping

  • Other factors – specify:

  • Lack of oxygen

  • Atmospheric contamination

  • Other factors – specify:


  • Come into contact with objects at high temperature

  • Be injured by fire

  • Other factors – specify:

  • Exposure to high temperatures

  • Exposure to low temperatures

  • Other factors – specify:

Can anyone come into contact with FLUIDS or GASES under HIGH PRESSURE due to:

  • Failure of the plant? Misuse of the plant?

  • Other factors – specify:

ERGONOMIC (incl Manual Handling) –

  • Seating design

  • Excessive effort

  • Poor lighting

  • Controls layout and design

  • Repetitive body movement or posture

  • Poor workplace or plant design

  • Lack of consideration for human behaviour causing mental or physical stress

  • Other factors – specify:

Can anyone be injured or suffer ill health from exposure to OTHER HAZARDS:

  • Chemicals Fumes Dusts

  • Vibration Noise Biologicals

  • Toxic gases or vapours

  • Ionising Radiation Non-Ionising Radiation

  • Other factors – specify:

Does the plant generate significant environmental aspects due to:

  • Energy consumption Hazardous emissions Water consumption

  • Nuisance noise Hazardous waste Dust

  • Other factors – specify:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.