Title Page
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Document No.
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Conducted on
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Assessor
- Nick Dorrington Team Leader
- John Milne Team Leader
- Christopher Scott Base Operative
- Adam Gribble Base Operative
- John Henderson Base Operative
- Daniel Murdoch Base Operative
- Steven Buchan Base Operative and Crane Operator
- Liam Murray HSSEQ Manager
- Mike Munro Operations Director
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Location
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Description of Task
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Reason for assessment
Completion Activities
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Assessor Signature
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Date discussed with employees
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Review Date
Assessment
Basic Overview
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Height of the working platform
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Work Duration
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Time between equipment moves
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Work Activity
Access Equipment
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Equipment in use
- Step Ladder
- Leaning Ladder
- Podium Steps
- MEWP Single User Boom
- MEWP Multi User Boom
- MEWP Single User Scissor Lift
- MEWP Multi User Scissor Lift
- Other
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Other (Specify)
Safe Working Load
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SWL of access equipment (KG)
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Maximum combined weight of operator(s), tools and materials (KG)
Declaration
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Can working at height be avoided?
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Working at height should not be completed, working at height must be avoided where alternative methods are reasonably practical
Detailed Assessment of Task
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Does the task involve:
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Holding tools or materials away from trunk
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Level of Risk
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Twisting/Leaning
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Level of Risk
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Working on or near fragile surfaces
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Level of Risk
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Strenuous pushing or pulling
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Level of Risk
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Insufficient rest or recovery
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Level of Risk
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A work rate imposed by a process
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Level of Risk
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Working on or near fragile surfaces
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Level of Risk
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Task Comments and Control Measures
Detailed Assessment of Working Environment
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The Working Environment- are there:
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Constraints on posture
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Level of Risk
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Poor floor conditions
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Level of Risk
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Uneven ground
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Level of Risk
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Overhead hazards
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Level of Risk
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Hot, cold or humid conditions
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Level of Risk
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Strong air movements
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Level of Risk
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Poor lighting conditions
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Level of Risk
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Environment Comments and Control Measures
Detailed Assessment of Individual
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The Individual – Does the job
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Call for special information and/or training e.g. IPAF
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Level of Risk
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Individual Comments and Control Measures
Other Factors
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Is movement or posture hindered by:
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Clothing
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Level of Risk
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Personnel Protective Equipment
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Level of Risk
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Other Factors Comments and Control Measures
Control Measures
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Measures in place
- Instruction and training
- Supervision
- Fall Protection
- Pre use inspections
- Emergency Plans
- Other
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Other Measures (Specify)
Additional Measures Required
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Additional Measure
Measure
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Details
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Responsible
- Nick Dorrington Team Leader
- John Milne Team Leader
- Christopher Scott Base Operative
- Adam Gribble Base Operative
- John Henderson Base Operative
- Daniel Murdoch Base Operative
- Steven Buchan Base Operative and Crane Operator
- Liam Murray HSSEQ Manager
- Mike Munro Operations Director
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Date Due
