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Site Address

Site Risk Assessment Form RA Ref No:

Assessor Job Title Assessment Date Review Dates / Initials

<<Name>> <<e.g. Foreman>> <<Date>> <<Dates>> <<Initials>>

Assessment task: Erecting/altering/striking scaffolding

Persons at risk Details Frequency Are any disabled? Comments

Contractors <<e.g. all operatives>> <<e.g. approx 8 hour/day>> Yes No
Visitors Yes No
Gen. Public / Others <<e.g. anyone in the vicinity>> Yes No
Hz Level of Risk
Hazard description How are persons affected? Existing controls Further controls / action
No. P S R
1 Manual handling e.g. Lifting or holding scaffold tubes <<e.g. Operatives attended Manual <<e.g. Supervisor to ensure that
especially above head height can <<e.g. <<e.g. <<e.g. Handling training session>> sufficient manpower is available at
cause muscle strain 3>> 3>> 9>> all times>>
2 Cuts and abrasions, e.g. Operatives may suffer cuts or <<e.g. Only experienced trained operatives <<e.g. Site supervisor to ensure that
pinch injuries fingers or hands or get them <<e.g. <<e.g. <<e.g. to wear suitable gloves where inexperienced operatives are
trapped while using tools or 4>> 3>> 12>> practicable>> supervised >>
manoeuvring tubes into position

3 Slips trips and falls e.g. Operatives can injure <<e.g. Operatives to be told to keep work <<e.g. Supervisor to ensure that
themselves if they trip over tubes or <<e.g. <<e.g. <<e.g. are clear>> work area is kept clean and tidy>>
fittings left lying around 4>> 3>> 12 >>

4 Falls from height e.g. Falls from ladders or from <<e.g. Only qualified scaffolders to <<e.g. Supervisor to assess need
scaffolding can cause serious <<e.g. <<e.g. <<e.g. erect/alter or strike scaffold>> for fall arrest harness etc>>
injuries 4>> 4>> 16>>

Probability (P)
Severity (S)
Risk (R)
5=very likely, 4=likely, 3=quite possible, 2=possible, 1=unlikely
5=fatal, 4=severe, 3=moderate, 2=slight, 1=negligible
0-8=low risk, no action required. 9-15=medium risk, ensure adequate controls are in use. 16-25=high risk, stop operation & implement control measures

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