Title Page
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Risk Assessment Title
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Location/Address
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Risk Assessment No.
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Conducted on
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Prepared by
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Current activity being undertaken on site
Site Specific Hazard Assessment
Site Specific Hazard Assessment
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ALL OF THE HAZARDS ASSOCIATED WITH YOUR WORK ARE CONTROLLED BY YOUR STANDARD SWMS (tick for yes)
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IS THERE A RISK OF FALLING 2M OR MORE?
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Control Measure
- Instruct workers to stay clear of drop zone
- Ensure edge and fall protection installed
- Wear harnesses
- Other
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If 'Other' selected what is your additional Control Measure?
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IS THERE A TRENCH DEEPER THAN 1.5M ONSITE?
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Control Measure
- Warn all workers of danger
- Instruct workers to stay clear of danger area
- Other
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If 'Other' selected what is your additional Control Measure?
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ARE YOU WORKING NEAR CHEMICAL, FUEL OR REFRIGERANT LINES? e.g. air conditioning refrigerants
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Control Measure
- Warn workers of danger
- Only trained competent people to work on lines
- Other
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If 'Other' selected what is your additional Control Measure?
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ARE YOU WORKING AROUND TILT-UP OR PRECAST CONCRETE ELEMENTS?
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Control Measure
- Warn all workers of danger
- Instruct workers to stay clear of danger area
- Other
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If 'Other' selected what is your additional Control Measure?
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IS THERE MOBILE PLANT IN THE WORK AREA? e.g. Excavators, Concrete pumps, Trucks
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Control Measure
- Make operator aware you are working in area
- Instruct workers to stay clear of danger area
- Other
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If 'Other' selected what is your additional Control Measure?
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IS THERE ANY DEMOLITION OF A LOAD-BEARING ELEMENT OF A STRUCTURE?
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Control Measure
- Warn all workers of danger
- Instruct workers to stay clear of danger area
- Other
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If 'Other' selected what is your additional Control Measure?
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ARE THERE ANY STRUCTURAL ALTERATIONS OR REPAIRS THAT REQUIRE TEMPORARY SUPPORT OR PREVENT COLLAPSE?
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Control Measure
- Warn workers of danger
- Instruct all workers not to destable supports in any way
- Other
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If 'Other' selected what is your additional Control Measure?
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ARE YOU WORKING ON OR NEAR, OR ADJACENT TO A ROAD, RAILWAY, SHIPPING LANE, OR OTHER TRAFFIC CORRIDOR IN USE BY TRAFFIC OTHER THAN PEDESTRIANS?
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Control Measure
- Alert workers to danger
- Keep all workers clear of public roads
- Other
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If 'Other' selected what is your additional Control Measure?
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IS THERE WORK ON OR NEAR PRESSURISED GAS MAINS OR PIPING? (e.g. if excavating near these)
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Control Measure
- Warn all workers to stay clear of excavation area
- Other
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If 'Other' selected what is your additional Control Measure?
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ARE YOU WORKING IN OR NEAR WATER OR OTHER LIQUID THAT INVOLVES A RISK OF DROWNING?
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Control Measure
- Keep all workers clear of area
- Other
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If 'Other' selected what is your additional Control Measure?
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ARE YOU WORKING IN OR NEAR A CONFINED SPACE?
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Control Measure
- Ensure all workers have confined space training
- Other
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If 'Other' selected what is your additional Control Measure?
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IS THERE ASBESTOS BEING DISTURBED AT THE WORKSITE?
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Control Measure
- Warn workers of danger and to stay clear
- Advise Site Supervisor
- Other
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If 'Other' selected what is your additional Control Measure?
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IS THERE A CONTAMINATED OR FLAMMABLE ATMOSPHERE?
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Control Measure
- Warn workers of danger and clear the area
- Contact Site Supervisor
- Other
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If 'Other' selected what is your additional Control Measure?
Sign Off
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Name & Signature of Inspector
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I have read and understood the content of this risk assessment
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Add worker
Name
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Add signature