PART 1a - Background (150 -200 words)

Name of Organisation (YOU CAN GIVE FICTIONAL NAME)

Site location (CITY, COUNTRY)
Number of workers (YOU MAY INCLUDE CONTRACTORS, DAILY WAGE WORKERS )

Description of the Organization (TO INCLUDE ACTIVITIES / SERVICES/ PROCESS DETAILS/ PRODUCTS
MANUFACTURED /SUPPLIED – DISTRIBUTED etc – INCLUDE SHIFT TIMINGS, WEEKLY OFFS etc.)

Risk Assessed areas - activities (SHOULD BE IN LINE WITH PART 2)

Any other relevant information (TO PROVIDE DETAILS OF RESPONSIBLE PERSON FOR ALLOCATING
RESOURCES, FOR TAKING IMPORTANT DECISIONS ON HEALTH AND SAFETY– DO NOT GIVE NAMES )

Part 1b - How the RA was carried out (200 Words)

Sources of information consulted (INTERNAL RECORDS - ACCIDENT REPORTS, INSPECTION RECORDS
etc. – EXTERNAL RECORDS – MSDS, LEGAL GUIDANCE REPORTS, ILO CONVENTIONS, LOCAL SAFETY
RULES etc. )
Who you spoke to (WORKER / SUPERVISOR / LINE MANAGER )
How you identified the hazard (OBSERVATION THROUGH WORKPLACE INSPECTION)
How you identified what is already being done (EXISTING CONTROLS THEIR ADEQUACY)
Any additional control / actions required (USE AN EXAMPLE OF ILO CONVENTION /
RECOMMENDATION YOU REFERRED FOR REDUCING RISK)

Part 2 - 10 HAZARDS (TO TAKE ONE EACH FROM 7 ELEMENTS + 3 FROM ANY ELEMENT)
COLUMN 1- REQUIREMENTS
E5 - Noise ( decibels – EQUIPMENT - ACTIVITY)
E5 - Vibration (type of equipment – MAGNITUDE )
E5 - Radiation ( type of radiation)
E5 - Mental ill-health ( type of stress)
E5 - Violence at work -(reasons/circumstances)
E5 - Substance abuse at work (evidence of abuse)
E6 - Work related upper limb disorders (ergonomics, work station design etc) –
( the details of the activity - movement requirement)
E6 - Manual Handling ( task, load details)
E6 - Load Handling Equipment-(type of equipment - type of material being lifted)
E7 - Hazardous Substances (chemical & biological substances) ( substance details, quantity)
E8 - Health, Welfare and Work Environment -(details of temperature/lighting/ventilation - why
workers are in that area)
E8 - Working at Height -(height of the work, equipment used to access the height)
E8 - Confined Spaces -(type of confined space - tunnel/tank/pipeline etc)
E8 - Lone Working (ACTIVITY - requirement details)
E8 - Slips & Trips ( causes, area details, purpose of the usage)
E8 - Movement of people & vehicles in the workplace (type of people, vehicles - details)
E8 - Work related driving -(type of vehicle, purpose of driving - site)
E9 - Work Equipment & Machinery - ( type of equipment, machinery, tools)
E10 - Fire ( reasons for fire - fuel, ignition, task details)
E11 - Electricity (voltage - equipment details)
COLUMN 2 - REQUIREMENTS
Who might be harmed and how? (People-how the harm will occur -what will be the harm –
consequences - injuries must be relevant to the category chosen)
COLUMN 3 - REQUIREMENTS
What are you already doing ?(Existing controls 3 minimum, – LESS EFFECTIVE)
COLUMN 4 - REQUIREMENTS
C4- What further controls and actions are required? ( additional controls 5 minimum + sequence of
hierarchy+ ilo convention )
ENSURE THAT ALL – ENGINGEERING Controls SHOULD BE SUPPORTED BY Administrative CONTROLS
(USE ATLEAST FEW OF THESE SUGGESTED ONES) -

1.SSOW to be in place – this has to be prepared upon worker consultation -2. Training – SPECIFIC
3. MOC – AS PER CHANGES, COMMUNICATED TO ALL RELEVANT PARTIES
4. PTW – ISSUED BY COMPETENT AUTHORITY
5. EMERGENCY PROCEDURES – TRAINED AND TESTED
6. INSPECTION TO BE CARRIED OUT AS REQUIRED
7. SIGNAGE & POSTERS MAY BE DISPLAYED
8. OPERTING INSTRUCTIONS FOR USE OF AN EQUIPMENT

REFERRED – ILO CONVENTION – ARTICLE NO.

COLUMN 5 - REQUIREMENTS
Timescales for further actions to be completed (within….) ( be realistic -
IF YOU WRITE DAILY OR IMMEDIATELY – JUSTIFY THE REASON IN A BRACKET)
COLUMN 6 - REQUIREMENTS
Responsible person’s job title (one or more for each control measure)

PART 3 - PRIORITIZE 3 ACTIONS & JUSTIFY THE SELECTION

Moral – (USE ORGANIZATION’S NAME – WRITE GENERIC CONSIDERING all activities - duty of care
towards employees etc - USE AN EXAMPLE)

Financial – (GROUP THE COSTS BETWEEN WORKERS/EQUIPMENT direct / indirect) (you may mention
that some of the costs may be insured but many costs cannot be insured – GIVE EXAMPLE)

JUSTIFICATION OF ACTIONS – 1 2 3
Action – (USE ONE CONTROL MEASURE FROM COL 4 OF PART 2 – SELECT ENGINEERING CONTROL
PREFERRABLY)
Specific Legal Arguments :( ILO / Country specific labour code or law) (100 - 150 Words)
USE SPECIFIC ILO CONVENTION / RECOMMENDATION - ARTICLE DETAILS - GIVE SUMMARY IN YOUR
OWN WORDS – YOU NEED TO QUOTE YOUR COMPANY NAME AND THE LOCAL RULES TOO IF
POSSIBLE
Consideration of likelihood (ALLOCATE LIKLIHOOD CATEGORIES IF POSSIBLE) (70-150 WORDS)
LIKLIHOOD – REASONS/ JUSTIFY
Severity (ALLOCATE Categories Minimal, Minor, Major & Catastrophic) (70 - 150 Words)
Severity set at - SELECT A CATEGORY FROM ABOVE AND JUSTIFY WITH THE CONSEQUENCES'
Controlling the Risk (100 - 150 Words)
Intended impact - REDUCTION IN LIKLIHOOD / SEVERITY - HOW THE CONTROL MEASURE SUGGESTED
WILL REDUCE THE IMPACT
Justification for timescale set by you in C5 of PART 2 - INCLUDE BUDGET ALLOCATION/PLACING THE
ORDER/INSTALLATION / TRAINING THE WORKERS ETC
Whether the action will fully control the risk - YOUR OPINION - WHETHER IT WILL FULLY CONTROL THE
RISK WITH FURTHER MAINTIANANCE ETC FOR EXAMPLE - INCLUDE THE OTHER CONTROLS
SUGGESTED IN COL 4 BY YOU TO MAKE IT EFFECTIVE – EXAMPLE USE OF PPE

PART 4 - REVIEW, COMMUNICATE & CHECK

Planned review date/period with
reasoning - CONSIDER ANY CHANGES SUGGESTED IN PART 2 WHICH MAY REQUIRE REVIEW (50-60
Words)

How the risk assessment findings will be communicated (USE ALL POSSIBLE METHODS OF
COMMUNICATION )AND who you need to tell (INCLUDE THE RESPONSIBLE PERSON FOR ENTIRE
ORGANIZATION, RESPONSIBLE PERSONS FROM COLUMN 5 - PART 2, WORKERS )(100-150 Words)

How you will follow up on the risk assessment to check that the actions have been carried out (YOUR
REMINDERS AND CHECKS TO FIND OUT ON THE PROGRESSION OF THE CONTROL MEASURES YOU
SUGGESTED IN THE PART 2 - COLUMN 4) (100-120 Words)

New format explanation – my recording for guidance

https://meeting.zoho.com/meeting/public/videoprv?recordingId=c705a82540b25b29dd73403284e