Title Page

  • Risk Assessment Title

  • Location/Address
  • Risk Assessment No.

  • Conducted on

  • Prepared by

  • Current activity being undertaken on site

Site Specific Hazard Assessment

Site Specific Hazard Assessment

  • ALL OF THE HAZARDS ASSOCIATED WITH YOUR WORK ARE CONTROLLED BY YOUR STANDARD SWMS (tick for yes)

  • IS THERE A RISK OF FALLING 2M OR MORE?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • IS THERE A TRENCH DEEPER THAN 1.5M ONSITE?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • ARE YOU WORKING NEAR CHEMICAL, FUEL OR REFRIGERANT LINES? e.g. air conditioning refrigerants

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • ARE YOU WORKING AROUND TILT-UP OR PRECAST CONCRETE ELEMENTS?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • IS THERE MOBILE PLANT IN THE WORK AREA? e.g. Excavators, Concrete pumps, Trucks

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • IS THERE ANY DEMOLITION OF A LOAD-BEARING ELEMENT OF A STRUCTURE?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • ARE THERE ANY STRUCTURAL ALTERATIONS OR REPAIRS THAT REQUIRE TEMPORARY SUPPORT OR PREVENT COLLAPSE?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • 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?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • IS THERE WORK ON OR NEAR PRESSURISED GAS MAINS OR PIPING? (e.g. if excavating near these)

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • ARE YOU WORKING IN OR NEAR WATER OR OTHER LIQUID THAT INVOLVES A RISK OF DROWNING?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • ARE YOU WORKING IN OR NEAR A CONFINED SPACE?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • IS THERE ASBESTOS BEING DISTURBED AT THE WORKSITE?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

  • IS THERE A CONTAMINATED OR FLAMMABLE ATMOSPHERE?

  • Control Measure

  • If 'Other' selected what is your additional Control Measure?

Sign Off

  • Name & Signature of Inspector

  • I have read and understood the content of this risk assessment

  • Add worker

  • Name
  • Add signature

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.