Customer Information

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

  • Dealer:

  • Customer:

  • Select date

  • Unit Location:

  • Add location
  • 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.

  • What type of work will be carried out?

  • Picture of Serial Number

  • Picture of Machine Hours if applicable

  • Have you supplied relevant pictures for the machine hours and serial number?

  • Picture of Serial Number

  • Picture of Machine hours

  • Service Technicians Name:

  • All TMs please sign:

Method Statement

  • Do you have the required permit and is this valid for your task?

  • Please select the valid permits

  • Method Statement:
  • Description

  • Identify Hazards

  • Probability Rating Task 1

  • Severity Rating Task 1

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

    Risk Scoring matrix.jpg
  • Enter result (Severity x Probability)

  • Identify Hazard

  • Probability rating Task 2

  • Severity Rating Task 2

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Identify Hazard

  • Probability rating Task 3

  • Severity Rating Task 3

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Do you want to add more hazards?

  • Identify Hazard

  • Probability Rating Task 4

  • Severity Rating Task 4

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

    Risk Scoring matrix.jpg
  • Enter result (Severity x Probability)

  • Identify Hazard

  • Probability Rating Task 5

  • Severity Rating Task 5

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Identify Hazard

  • Probability Rating Task 6

  • Severity Rating Task 6

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Do you want to add more hazards?

  • Identify Hazard

  • Probability Rating Task 7

  • Severity Rating Task 7

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Identify Hazard

  • Probable Rating Task 8

  • Severity Rating Task 8

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Identify Hazard

  • Probable Rating Task 9

  • Severity Rating Task 9

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Identify Hazard

  • Probable Rating Task 10

  • Severity Rating Task 10

  • Please multiply both figures to gain the overall Risk Rating Priority. (Severity x Probability)

  • Enter result (Severity x Probability)

  • Service Engineer Name

  • Service Engineer Signature

  • Name:

  • Signature:

  • Name:

  • Signature:

  • Name:

  • Signature:

  • Customer Name

  • Signature:

  • Name:

  • Signature:

Risk Assessment

  • Have you reported in?

  • Have you completed the site induction?

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

  • 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.

  • Are you suffering from fatigue?

  • 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 all the necessary tools/equipment to work safely?

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

  • Please remove tools from service and inform manager of the defaults.

  • Please indicate what tools/equipment are required to complete the work safely?

  • If using hazardous substances, are you aware of all the relevant safety data sheets and hazardous information?

  • Please contact your manager and request the COSHH document

  • Is there clear access & egress around the working area?

  • Please indicate how you intend to limit the hazards while working around a congested area

  • 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.

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

  • Please contact your manager immediately and inform him/her of the situation

  • Are you equiped with the suitable PPE?

  • Please select the PPE required for this job

  • Please select those that are missing

  • 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?

  • Contact site manger, and Service manager to plan a safer method of working

  • Is there a risk on site of anything falling and causing injury to others?

  • Please review your work area and remove those items that could fall on others.

  • Does the job involve lifting?

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

  • Contact manager to arrange for lifting plan to be emailed, or discuss the next steps to take.

  • Enter the Lifting plan number.

  • If there are any interlocks or guarding on the machine, can I confirm they work correctly?

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

  • Contact the site manager to arrange a safer way of working.

  • Can I protect myself against falls from height?

  • Can i minimize the risk of falling?

  • Please indicate methods used to minimize the risk of falling at height

  • Please contact your manager to discuss the next step forward

  • Do I need to obtain authorization before entering a confined space?

  • List the person responsible for coordinating a rescue plan.

  • Please select the rescue equipment

  • Where is the equipment located?

  • What method of communication is in place?

  • Have I PAUSED and asked for help from my supervisor if a condition is not safe or I cannot take these actions.

Confirmation

  • Are you happy that you can proceed with this job in a safe manner?

  • Please contact you manager with any concerns before beginning the job.

Near Misses

  • Accidents are sadly a feature of everyday life; they are not planned and certainly not wanted. 
    The company is committed to best practice in HSE performance to meet its responsibilities for the health, safety and wellbeing of its team members, visitors and others who may be affected by its work activities.

    DEFINITIONS
    Hazard – Something with the potential to cause harm, including ill health, injury, loss of product and/or damage to plant and property.
    A Near Miss - An undesired event in which there was no injury; however, under slightly different circumstances could have resulted in personal harm – Terex

    An Accident - an undesired event which results in:
    Harm to people (fatality, occupational injury or occupational illness) and/or
    Damage to vehicles, assets, facilities and/or
    Damage to the environment

  • Please state any accidents, near misses or Hazards experienced while completing this job.

Service Report & Customer Sign Off

  • Reason for visit

  • Model:

  • Serial Number:

  • Engine Hours:

  • Crushing Hours:

  • Select date

  • Summary of issues/Work Carried out:
  • Description:

  • Add media

  • Assign Issue too?

  • Outstanding work / Issues:
  • Description

  • Add media

  • Assign Issue too?

  • Advisory to customer

  • Parts used

  • Parts required

  • Service Engineer Print Name:

  • Add signature

  • Select date

  • Customer Print Name:

  • Add signature

  • Select date

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