Information
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Site conducted
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This document is here to help and assist you in the Risk Assessment and to support the customer in delivering a safe and good service.
Please take a few minutes to complete all elements within this assessment as much as possible, once complete ensure that all signatures are completed.
Ensure that the customer receives a copy of this Risk Assessment.
Thank you for your co-operation.
Customer Information
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Please provide a job description of the work your are going to carry out
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Dealer:
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Customer:
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Unit Location:
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Site Location
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Date & Time
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Picture of Serial Number
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Picture of Machine Hours if applicable
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Number of Team Members attending site?
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Please ensure that the contents of this risk assessment are shared with all those TM's involved in this activity.
Method Statement
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What type of work will be carried out?
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Do you have the required permit and is this valid for your task?
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Please select the valid permits
- Hot Work Permit
- Confined Spaces Permit
- Working at Height Permit
- Electrical Permit
Method Statement:
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Description
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Identify Hazards
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probability Rating Task 1
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Severity Rating Task 1
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probability rating Task 2
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Severity Rating Task 2
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probability rating Task 3
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Severity Rating Task 3
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Do you want to add more hazards?
- Yes I have identified more hazards
- No I am happy to continue
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probability Rating Task 4
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Severity Rating Task 4
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probability Rating Task 5
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Severity Rating Task 5
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probability Rating Task 6
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Severity Rating Task 6
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Do you want to add more hazards?
- Yes I have identified more hazards
- No I am happy to continue
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probability Rating Task 7
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Severity Rating Task 7
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probable Rating Task 8
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Severity Rating Task 8
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Identify Hazard
- Access and Egress
- Plant/Vehicle Movements
- Confined Space Entry
- Other workers in Vicinity
- Noise
- Vibration
- COSHH Substances
- Poor Weather conditions
- Poor Lighting
- Manual Handling - Lifting
- Air Born Particles
- Working at Height
- Unprotected Edges
- Fragile Surfaces
- Falling Objects
- Overhead Obstructions
- Mobile Cranes - Slinging
- Entanglement / Crushing
- Fire
- Blasting/ Explosion
- Hot Work / Weld Grind
- Climbing
- LPG / Oxy / Propane
- Combustible Materials
- Repetition
- Oxygen Enrichment/ Depletion
- Electrical
- Tracking Machine
- Pneumatic/Hydraulic
- Pressurised Systems
- Stored energy
- Slips, Trips and Falls
- Flying Particles
- Contact with Sharp Edges
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Probable Rating Task 9
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Severity Rating Task 9
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Identify Hazard
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Probable Rating Task 10
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Severity Rating Task 10
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Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)
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Enter result (Severity x Probability)
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Service Engineer Name
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Service Engineer Signature
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Name:
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Signature:
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Name:
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Signature:
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Name:
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Signature:
Risk Assessment
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Have you reported in?
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Have you completed the site induction?
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Are you aware of the customers site safety rules, emergency procedures and rescue plans?
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Please make sure that people within the site know you are working in the area, and ensure you have a point of contact within the job site before commencing job.
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Are you suffering from fatigue?
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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.
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Have all sources of electrical energy been isolated?
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Have electrical systems been checked to verify isolation? Zero Energy?
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Are lock outs, tags, barricades and signage installed and clearly visible?
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If you are working on any hydraulic systems, have they been isolated and checked for stored energy?
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Have all elevated and raised objects been lowered, locked or supported to prevent falling?
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Do you have all the necessary tools/equipment to work safely?
- Yes I have all the tools required
- No I do not have the tools required
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Are any power tools to be used in a good and safe condition?
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Please remove tools from service and inform manager of the defaults.
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Please indicate what tools/equipment are required to complete the work safely?
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Have all sources of electrical energy been isolated?
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If using hazardous substances, are you aware of all the relevant safety data sheets and hazardous information?
- Job does not require the use of hazardous substances
- I am using hazardous substances and i am aware of the relevant data sheets
- I am using hazardous substances but I am not aware of the COSHH documents
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Please contact your manager and request the COSHH document
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Is there clear access & egress around the working area?
- Yes the area I am working is clear
- No the area has not got clear access and egress around the working area
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Please indicate how you intend to limit the hazards while working around a congested area
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Can I spill or pollute something?
- Yes, but i have a spill kit available
- No I wont spill or pollute something
- Yes, but i do not have a spill kit available
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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.
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Is there sufficient natural light/arificial lighting to work safely?
- Yes the lighting around the work area is good
- No the lighting is not sufficient to work safely
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Please contact your manager immediately and inform him/her of the situation
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Are you equiped with the suitable PPE?
- Yes I have all the appropriate PPE required for the task
- No I have not got the suitable PPE required
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Please select the PPE required for this job
- Safety Footwear
- Overalls
- Gloves
- Safety Helmet
- Safety Glasses
- Ear Protection
- Fall Arrest Harness and Lanyard
- High Vis Clothing
- Waterproofs
- Visor
- Goggles
- Dust Mask
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Please select those that are missing
- Safety Footwear
- Overalls
- Gloves
- Safety Helmet
- Safety Glasses
- Ear Protection
- Fall Arrest Harness and Lanyard
- High Vis Clothing
- Waterproofs
- Visor
- Goggles
- Dust Mask
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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
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Can I stand clear of the danger Zone from unstable / suspended loads?
- Yes, I can stand clear of suspended or unstable loads
- No I cannot stand clear of suspended or unsteady loads
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Contact site manger, and Service manager to plan a safer method of working
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Does the job involve lifting?
- Yes a lift is required for the job
- No lift is required to complete the job
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If there are any interlocks or guarding on the machine, can I confirm they work correctly?
- Yes the interlocks and guarding works correctly
- No, there is a fault with the interlocks and guarding
- There are no interlocks or guarding on the machine
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Can I position myself in a safe zone in relation to moving equipment?
- Yes I can position myself in a safe zone
- No i cannot position myself in a safe zone in relation to moving equipment
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Contact the site manager to arrange a safer way of working.
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Can I protect myself against falls from height?
- Yes I can protect myself from falls at height
- No I cannot protect myself against falls at height
- No working at height is required
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Can i minimize the risk of falling?
- Yes I can minimize the risk of falling
- No I cannot minimize the risk of falling
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Please indicate methods used to minimize the risk of falling at height
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Please contact your manager to discuss the next step forward
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Do I need to obtain authorization before entering a confined space?
- No, the job does not require working in a confined space
- Yes, working in confined space is required
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List the person responsible for coordinating a rescue plan.
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Please select the rescue equipment
- Crane
- Digger
- Scissor lift
- MWEP
- Winch
- Harness
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Where is the equipment located?
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What method of communication is in place?
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Have I PAUSED and asked for help from my supervisor if a condition is not safe or I cannot take these actions.
- Yes I have spoke to my manager and we have agreed a plan in order to complete the work safely
- No, all conditions are safe to continue on with the job
Confirmation
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Are you happy that you can proceed with this job in a safe manner?
- Yes, the job is safe for me to carry on
- No, I do not feel the job is safe enough to continue on with the job
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Please contact you manager with any concerns before beginning the job.
