Vibration Risk Assessment Template

• Site

• Location
  Address

• Shift

• Full Name of Construction Manager

• Date of Assessment

  Date

Vibration Risk Assessment Template

• Workers using vibrating tools or equipment

WORKER

• Full Name

• Current Job Description

Vibrating tool or equipment to be used

• Select vibrating tool or equipment to be used

  Select Concrete breaker Hammer drill Grinder Disc Cutter Sander Chipping hammer Needle gun Other

  • Concrete breaker
  • Hammer drill
  • Grinder
  • Disc Cutter
  • Sander
  • Chipping hammer
  • Needle gun
  • Other

• Specify vibrating tool or equipment

• Vibration Magnitude

• Set Time Limit

• Full Name and Signature of Construction Worker

  Sign

Completion

• Additional Observations

• Vibration levels are accurately monitored and HAVS exposure are controlled by setting time limits and job rotation.

• Full Name and Signature of Construction Manager

  Sign