Title Page

  • Document No.

  • Conducted on

  • Assessor

  • Location
  • Description of Task

  • Reason for assessment

Completion Activities

  • Assessor Signature

  • Date discussed with employees

  • Review Date


Basic Overview

  • Height of the working platform

  • Work Duration

  • Time between equipment moves

  • Work Activity

Access Equipment

  • Equipment in use

  • Other (Specify)

Safe Working Load

  • SWL of access equipment (KG)

  • Maximum combined weight of operator(s), tools and materials (KG)


  • Can working at height be avoided?

  • Working at height should not be completed, working at height must be avoided where alternative methods are reasonably practical

Detailed Assessment of Task

  • Does the task involve:

  • Holding tools or materials away from trunk

  • Level of Risk

  • Twisting/Leaning

  • Level of Risk

  • Working on or near fragile surfaces

  • Level of Risk

  • Strenuous pushing or pulling

  • Level of Risk

  • Insufficient rest or recovery

  • Level of Risk

  • A work rate imposed by a process

  • Level of Risk

  • Working on or near fragile surfaces

  • Level of Risk

  • Task Comments and Control Measures

Detailed Assessment of Working Environment

  • The Working Environment- are there:

  • Constraints on posture

  • Level of Risk

  • Poor floor conditions

  • Level of Risk

  • Uneven ground

  • Level of Risk

  • Overhead hazards

  • Level of Risk

  • Hot, cold or humid conditions

  • Level of Risk

  • Strong air movements

  • Level of Risk

  • Poor lighting conditions

  • Level of Risk

  • Environment Comments and Control Measures

Detailed Assessment of Individual

  • The Individual – Does the job

  • Call for special information and/or training e.g. IPAF

  • Level of Risk

  • Individual Comments and Control Measures

Other Factors

  • Is movement or posture hindered by:

  • Clothing

  • Level of Risk

  • Personnel Protective Equipment

  • Level of Risk

  • Other Factors Comments and Control Measures

Control Measures

  • Measures in place

  • Other Measures (Specify)

Additional Measures Required

  • Additional Measure

  • Measure
  • Details

  • Responsible

  • Date Due

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.