Title Page
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Site conducted
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Location
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Activity Assessed
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Add a detailed description of activity via notes or add as media (video or .pdf)
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Version number
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Purpose of new version
- general review (2 years since last review)
- Due to an accident
- Due to change in process
- Risk assessment no longer suitable
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Add detailed description of review
Asset
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Assessment Date
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Review Date
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Assessor (name)
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Assisted by (names)
Hazard List
- Add a Hazard
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Select your Hazard
- Contact with electricity (more than mains voltage)
- Contact with static electricity
- Contact with moving machinery parts
- Contact with moving object
- Contact with moving vehicles
- Contact with stationary object
- Contact with needle stick or open blade
- Contact with objects at height
- Contact with hazardous materials
- Contact with dusts
- Contact with radiation
- Contact with biohazards
- Contact with pressurised systems
- Lifting objects using mechanical aids
- Lone working
- Moving heavy objects (manually)
- Repetitive movements
- Slippery or uneven surfaces
- Falling from height
- Working at night/ shift work
- Working with open flames/ hot work
- Working with deep water
- Working in low/ high temperatures
- Working with loud noises/ long term noise
- Other unlisted hazard
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What is the source of Hazard?
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Who is exposed?
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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What are the existing controls?
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What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
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What would be the impact of the injury/ disease/ damage? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
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Risk number is:
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The risk rating for this hazard is Very Low
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The overall Risk Rating for this hazard is Low
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The overall risk rating for this hazard is Medium
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
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The risk rating for this hazard is High - consider an action to reduce the risk level
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The risk rating for this hazard is Very High
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The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
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Use the Risk Matrix to determine the risk rating for this hazard
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please first go and complete the risk assessment for COSHH/ handling hazardous materials and ensure you have a current safety data sheet available
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
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What would the impact of the injury/ disease/ damage be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
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Risk number is:
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The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
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The risk rating for this hazard is Very Low
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The risk rating for this hazard is Low
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The overall risk rating for this hazard is Medium
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The risk rating for this hazard is High - consider an action to reduce the risk level
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The risk rating for this hazard is Very High
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Use the Risk Matrix to determine the risk rating for this hazard
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please first complete the risk assessment for Manual handling
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
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What would the impact of the injury/ disease/ damage be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
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Risk number is:
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The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
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The risk rating for this hazard is Very Low
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The risk rating for this hazard is Low
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The overall risk rating for this hazard is Medium
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The risk rating for this hazard is High - consider an action to reduce the risk level
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The risk rating for this hazard is Very High
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
- 20-25 Extreme
- 15-19 Very High
- 10-14 High
- 5-9 Medium
- 3-4 Low
- 1-2 Very Low
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
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Other Hazard
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
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What would the impact of the injury/disease/ damage be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
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Risk number is:
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The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
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The risk rating for this hazard is Very Low
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The risk rating for this hazard is Very Low
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The overall risk rating for this hazard is Medium
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The risk rating for this hazard is High - consider an action to reduce the risk level
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The risk rating for this hazard is Very High
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
- 20-25 Extreme
- 15-19 Very High
- 10-14 High
- 5-9 Medium
- 3-4 Low
- 1-2 Very Low
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
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What is the radiation type?
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What is the source of Hazard?
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Who is exposed?
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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What are the existing controls?
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What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
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What would the impact of the injury/disease be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
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Risk number is:
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The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
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The risk rating for this hazard is Very Low
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The risk rating for this hazard is Low
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The overall risk rating for this hazard is Medium
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The risk rating for this hazard is High - consider an action to reduce the risk level
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The risk rating for this hazard is Very High
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
- 20-25 Extreme
- 15-19 Very High
- 10-14 High
- 5-9 Medium
- 3-4 Low
- 1-2 Very Low
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An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
Control Measures and Personal Protective Equipment Required
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Are machinery protection devices (guards, interlocks) used as a control measure for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is there a specific system of work (e.g. SSW, JSA, Work at Height Permit) required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Basic Personal Protective Equipment (PPE) must be worn in accordance with local site rules.
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What PPE is required for this task?
- Hearing Protection
- Eye Protection
- Respiratoty Protection
- Hand Protection
- Head Protection
- Fall from Height protection
- Protective Clothing/ Coveralls
- Foot Protection
- Hi-Visibility Clothing
- Other
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Specify Hearing Protection Type/ Grade
- EN352 Disposable ear plugs
- EN352 Reusable ear plugs
- EN352 Over ear defenders
- EN352 Communication Ear defenders
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Task / Hazard Controlled
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Specify Eye Protection Type/ Grade
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Task / Hazard Controlled
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Specify Respiratory Protection Type/ Grade
- EN136 - face/dust mask
- EN136 - respirator - face fit required
- self contained breathing apparatus - training required
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Task / Hazard Controlled
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Specify Hand Protection Type/ Grade
- EN388 Puncture resistant
- EN388 Cut resistant
- EN388 Impact resistant
- EN388 Abrasion resistant
- EN374 Chemical resistant
- EN407 Thermal (heat) resistant
- EN511 Thermal (cold) resistant
- EN388 Vibration resistant
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Task / Hazard Controlled
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Specify Protective coveralls/ clothing Type/ Grade
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Task / Hazard Controlled
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Specify Head protection type
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Task/ Hazard controlled
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Type/ grade of fall arrest equipment
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Hazard/ Task controlled
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Type/ grade of foot protection
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Task/ hazard Controlled
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What other PPE type is required? (include grade and style)
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Task/ Hazard Controlled
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Specify Type/Grade
- EN471,2 Hi Vis Vest front fastening
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Task / Hazard Controlled
Sign off
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Manager's Name & Signature
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This document must now be communicated with all relevant persons
