Simple to follow form

1. RISK ASSESSMENT ZONE LOCATION RISK ASSESSMENT
UK Security
Clive Burgess H&S Manager Check sheet Clive Burgess© 2005 See Plan of Plant Number Running order
Must be use when training new employees
1 Activity: Work carried out by employee whilst on duty at work and being Task involved: Tasks employee must carry out to perform the
risk assessed now activity being risk assessed now
Those persons at risk: Trainees, Unified Grades,
Hazards which could result in significant harm: Distributors, Transporters, Representatives, Is a Manual
Hazards should be listed in numerical order, each in turn having a control Contractors, Administrative grades, Specialists Handling
measure to reduce the likelihood of occurrence. This will include such things (Doctors, Occupational Nurse, Union Risk
as: Slips, trips and falls Manual handling, Lack of maintenance Lack of Representatives), Official Visitors, Unofficial Assessment
instruction, Use of tools/equipment, Fire/smoke, Hazardous Substances, Visitors, Maintenance Staff, Cleaners, Pregnant required?
Noise, Electricity, Dust and fumes, Vibration, WRULDS, Drugs and Alcohol Workers, Lone Workers
Abuse, Workplace Stress, Lifting Equipment, Self Propelled Vehicles, Other Manual Handling of Loads: Assessment checklist Reference:
Cross
vehicles such as Flts and Lorries, Cuts, Crushing, Scalds, Access, Egress –‘Take Action… and Check That It Has the reference
Desired Effect.’ Page 48, 49 M.HoLR 1992
(ACOP)
2 With no control Risk Probability: Please refer to the instructions on using Nomogram for Risk Assessor 1:
measures in place Calculation Exposure: each hazard encountered and what you are required to enter Rating Name and
Likelihood of Potential in this section- Calculation must indicate if the chance of this position as
occurrence:
h Outcome – Injury: happening as, high, medium or low indicated on
safety policy
CURRENT CONTROL MEASURES: List all current control methods used, indicate on assessment where these are located or Assessor 2:
can be found. They must be readily available for all employees to see. References must be made to: Adherent to relevant As above
regulations (specify), Safe System Of Work/Instruction (Specify), Planned Maintenance (Specify), Staff Training Six months Initial
Training Package including induction training, Annual Training, (SSTs), Communications (SIRs, Observations – BSI – SHE – DATE Assessed
3 BSO, Meetings, Company Bulletins), Safety Zone System, Guarding, Interlocking Gates, E stops, Signs And Signage, Adequate
supervision for experience and ability of staff, Environmental monitoring, Health surveillance, Personal Protective Equipment
(Specify – Head, Neck, Ears, Eyes, Face, Hand, Leg, Foot, Person) Short duration breathing apparatus
Approved by:
Date
With current Risk Probability: Reassess the chance of this happening, high, medium or low Risk
control measures
Risk Assessments mustCalculation Exposure:
be reviewed after accidents, Risk assessments must be reviewed after accidents, changes in Rating
in place Potential Work methods, new equipment and at least, every three years Review Date
Likelihood: Outcome – Injury: