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Risk Assessment Format and Work Sheet
Risk Assessment Format and Work Sheet
1. Identify the risk 2. Identify people at Risk 3. Identify precautions already in place 4. Identify impro
Mobile Equipment
Fork lifts- Suitable for intended use; good stability; bright colour; good all round visibility;
fitted with mirrors, horn, lights, reverse lights & alarm, seat belt, driver roll over protection,
speed limiter.
Cranes, hoists & lifting accessories- Suitable for intended use; horn or alarm; flashing
beacon; up / down limits; hook safety clips; suitable & certificated accessories
Drivers / Crane Operators - Trained and certificated. Retested every 3 years.
Pre-Operational Checklists
Maintenance of vehicles / cranes / hoists
Medicals (Fork lift & Crane) - Done prior to training and annually after test
Delivery vehicles (to and from site)
Other vehicles
Other traffic (including rail)
Vehicle routes- segregated from pedestrians; separated from doors, gates; suitably
marked; wide enough for the largest vehicle; overhead hazards; blind and sharp corners;
Pedestrian routes segregated from vehicles; ventilated as necessary; speed limit;
reversing kept to minimum
Pedestrian routes - Segregated from vehicle movements and entry / exit doors; route
from pedestrian exit barriered off from vehicle door; crossing points (zebra); inward
opening gates at crossing points; clear signage
Loading / Unloading - Passing pedestrians & vehicles; contact with overhead cables;
steep gradients; uneven road or yard surfaces; unsuitable or uneven load stability; trailer
creep (sunken loading bays); driver not away from vehicle
Fall Control
Identify all tasks where a fall could injure or kill
Lack of fall prevention platforms
Lack of fall protection equipment and certified anchor points
Portable and fixed ladders
Scaffolding
Mobile access platforms ("Sky Lifts")
Falling objects
Roof work
Same level falls
Fragile surfaces
Confined Spaces
Fire and explosion
Fire and explosion from oxygen enrichment
Loss of consciousness or asphyxiation from gas, fume or vapour
Asphyxiation from lack of oxygen
Loss of consciousness from increase in body temperature
Hypothermia from decrease in body temperature
Asphyxiation or trapping from free flowing solids
Roof work
Same level falls
Fragile surfaces
Confined Spaces
Fire and explosion
Fire and explosion from oxygen enrichment
Loss of consciousness or asphyxiation from gas, fume or vapour
Asphyxiation from lack of oxygen
Loss of consciousness from increase in body temperature
Hypothermia from decrease in body temperature
Asphyxiation or trapping from free flowing solids
Poisoning from toxic dusts, vapours or gases
Burns from corrosives
Restricted access / exit
Restricted working space
Falls from height
Slips, trips, falls (same level)
Falling objects
Poor visibility
Energy isolation procedures (LTV)
Noise
Rescue procedures
1-9
Consequence
L 1 2 3 4 5
i 10-15
k 1 1 2 3 4 5
e 16-25
l
i
h
o
L
i
k 1 1 2 3 4 5
e 16-25
l 2 2 4 6 8 10
i
h 3 3 6 9 12 15
o
o 4 4 8 12 16 20
d
5 5 10. 15 20 25
ety Risk Assessment
rioritise and carry out corrective actions 6. Record the results 7. Routinely review the assessment
Energy Isolation
od all round visibility; "Energy Isolation" to cover Lock Out, Tag Out and Verify for both "Complex" machinery
er roll over protection, (i.e. an extrusion press and all handling plus ancillary equipment) and "Simple" machinery
(i.e. a lathe). Energy isolation will include all forms of energy and stored energy.
orn or alarm; flashing Risk - due to no or only partial Energy Isolation Procedures risk to persons of
cessories injuries such as:
ry 3 years. Entanglement, Trapping and / or nipping, Crushing, Impact, Burns (heat and chemical),
Scalding, Cutting and / or severing, Falling and / or falling objects, Drowning, High
pressure fluid or air pressure injection, Electric shock.
fter test
Machinery Safety - Mechanical
Crushing
Shearing
s, gates; suitably Cutting and / or severing
d and sharp corners; Entanglement
y; speed limit; Trapping and / or nipping
Impact
/ exit doors; route Stabbing and / or puncture
(zebra); inward Friction and / or abrasion
High pressure fluid or air injection
overhead cables; Slips, trips, falls
n load stability; trailer Falling objects
Burns
Electrical
Direct contact
Indirect contact
Short circuit / overload
As a source of ignition
Electrostatic potential
Housekeeping (minimum)
Slips, trips, falls
Spillages
Lack of spill kits
Lack of waste removal
Exposure risk byInhalation, Ingestion, Skin contact
To substances classified asVery Toxic, Toxic, Corrosive, Harmful, Irritant, Carcinogens,
Mutagens, Biological Agents In the form of Solids, Dusts, Fume, Smoke, Liquids, Vapour,
Mists, Aerosols, Gases.
Workplace exposure limits not known.
Exhaust Extraction and Breathing Zone monitoring / analysis not carried out.
Housekeeping (minimum)
Slips, trips, falls
Spillages
Lack of spill kits
Lack of waste removal
Lack of waste containers
Flammable waste not segregated
Flammable items not in fire proof storage
Smoking in unapproved areas
Blocked walkways, doorways, vehicle routes
Incorrect storage leading to any above
Noise
Noise levels in working areas not known.
Noise level known to be at or above 85dB(A) daily exposure or 137dB(C) peak sound.
Engineering control measures not in use.
Hearing protectiion not issued / not worn.
Personnel Hearing Tests (audio) not carried out.
6-25 High
6-25 High
<30 days
essment
Manual Handling
plex" machinery Weight Guideline - must be within the capability of the individual but as a guide
Simple" machinery for a standing person:
d energy. Female: Floor level 7kg next to the body; 3 Kg at arms length. Waist level 16kg next
o persons of to the body; 10kg at arms length. Head level 7kg next to the body; 3kg at arms length
Male: Floor level 10kg next to the body; 5kg at arms length. Waist level 25kg next to
at and chemical), the body; 15kg at arms length.
wning, High Head level 10kg next to body; 5kg at arms length.
Seated work at waist level; Female 3kg. Male 5kg
Risks
Actions - Lifting and lowering weights outside the guidelines. Carrying weights
without resting above 10m distance. Pulling and pushing loads requiring excessive
force to start and maintain movement. Twisting the body (trunk). Stooping at the
waist. Sudden movement of the load.
Frequent or prolonged physical effort. Effects of PPE and clothing.
Load - Load too heavy? Load difficult to hold on to? Load unstable? Load sharp, hot
etc?
Working area - Lack of space? Slippery, unstable or uneven floors? Steps to have to
walk up or down? Extremes in high and low temperatures? Gusts of wind or
inadequate ventilation?
Other - Pregnant worker? Young worker? Previous injury or ill-health?
ying weights
quiring excessive
tooping at the
s? Steps to have to
of wind or
lth?
urning. Powered
sound.
micals. Oils.
mical. Molten
Wet conditions.
for vehicle
ection for
Wet conditions.
for vehicle
ection for
Blocked or locked
e.
Date of Assessment:
Clear identification on
Driver training racks
Inspection process by
Operator training operators
Inspection process by
Driver training operators
4
Current Control Measures
Consequence of
Harm
5
5
5
5
Likelihood of Harm
Being Caused
2
4
2
2
Risk Rating
10
20
10
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Heath and Safety
Action Plan
Reference
Law
Additional Control Measures Required Priority of Action.
4
3
2
1
Business Case
Current Condition
Describe
Future Condition
Action Plan
See attached she
Measurements
See attached sheet
Health and Safety Action Plan
Risk assessment
Reference Description
nd Safety Action Plan