Customer Information

  • Please provide a job description of the work your are going to carry out to support this Hazard Assessment

  • CRM No:

  • SAP No:

  • Customer:

  • Select date

  • Unit Location:

  • Add location
  • Service Technicians Name:

  • Number of Team Members working on this activity?

  • Please ensure that the contents of this risk assessment are shared with all those TM's involved in this activity.

  • Model:

  • Serial No:

  • Please take photograph of the Serial Number of the machine you are working on

  • Mileage (miles/kms*) please state which (If applicable)

  • Hours operation of machine:

  • Registration No: (If Applicable)

Risk Assessment

  • Have you reported in?

  • Are you aware of the customers site safety rules, emergency procedures and rescue plans if working at height?

  • Are you fit and well to carry out the task?

  • You should immediately consult with your manager and discuss your well being and agree the next course of action. Your manager should also contact the customer and provide feedback.

  • Do you have the required safe system of work and is this valid for your task?

  • Please select those safe systems of work that apply to this activity

  • Are you and the machine in a safe and suitable environment?

  • Is there a requirement to Lock Out/Tag Out the equipment you are working on and have you completed this?

  • Please verify that you have Locked, Tagged and Verified that the isolation's are in place, and secure

  • If a lifting operation is to take place, do you have a lifting plan?

  • Is all lifting equipment certified and in the current test period, is it also suitable for the job?

  • If you are working at height, do you have the correct protection to prevent you falling?

  • Please check your equipment and ensure that you have a clip on point, if you do not PAUSE the job and seek assistance and advice.

  • Do you have all the necessary tools/equipment to work safely?

  • If using hazardous substances, do you have all the relevant safety data sheets and hazardous information?

  • Can I cause something to fall on someone else?

  • Please review your work area and remove those items or secure those items that could fall on to others

  • Can I strain or overexert myself?

  • Do not place yourself at risk by carrying out an activity that would lead to overexertion or strain yourself, do not take risks.

  • Do you have clear access & egress to carry out your task?

  • Can I spill or pollute something?

  • Ensure substances are secure and material is in the correct container, to prevent spills or pollute the environment you are working in. Understand the sites spills process and how to clean up, ensure spill kits are close by.

  • Are you aware of local environmental procedures for oil spillages, pollution, noise etc?

  • Is there sufficient natural light/arificial lighting to work safely?

  • Are the weather condition's acceptable to carry out the task?

  • Consider weather conditions, and if the weather should change during your activity what are your control measures or changes you will make to ensure your safety and that of the team.

  • Are any power tools to be used in a good and safe condition?

  • Are you or other personnel suitably qualified to operate any of the product/equipment in use?

  • Are you equiped with the suitable PPE?

  • Please select those that apply

  • WARNING - If you are not able to ensure your own safety to any of the above questions, JOB PAUSE, ASSESS and RESOLVE the issue with the customer. If this is not possible then escalate this to your relevant supervisor/manager.

Life Saving Behaviors

  • Can I stand clear of the danger Zone from unstable / suspended loads?

  • Can I follow my my lifting plan: No Plan, No Lift?

  • Can I check that my interlocks and guarding work correctly on my equipment and I never bypass them?

  • Can I position myself in a safe zone in relation to moving equipment?

  • Can I protect myself against falls from height?

  • Can I obtain authorization and validate air quality before entering a confined space?

  • Can I wear my seat belt?

  • Have I PAUSED and asked for help from my supervisor if a condition is not safe or I cannot take these actions. If a near miss occurs, I report it immediately?

  • Has the Scope of Work changed?

  • Then PAUSE the job, review and ensure that the hazards and controls you have in place are correct and have not changed.

  • Please provide signature

  • Select date

  • Please provide siganture

  • Select date

Service Report & Customer Sign Off

  • THIS SECTION IS NOT MANDATORY AT THIS MOMENT IN TIME, PLEASE GO TO COMPLETING THIS FORM AND THEN SEND TO YOUR TEREX TEAM CONTACTS

  • Reason for visit

  • Reported fault and rectification report

  • Add media

  • Outstanding work to be completed

  • Advisory to customer

  • Parts used

  • Parts required

  • Add signature

  • Select date

  • Add signature

  • Select date

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