1. RISK ASSESSMENT
1. Assessment number 2. Date
3. Assessed by Alex Michael Safe and Sound 4. Item/Task/Activity Assessed Installation of flagpoles
5. Equipment Serial Number 6. Location
7. End User Consulted 8. Assessment Type Original $ Annual Design Post Accident
9. Relevant Statutory Provision Health and Safety At Work Act 1974, Manual Handling Regulations
PROBABILITY WORST CASE
17. PERSON
13. 14. 15. Risk
RESPONSIBLE FOR
10. 12. WHOM Severity Likelihood Rating
Item 11. HAZARD and OUTCOME Low 16. RISK CONTROL ADVISORY ENSURING
IS AT RISK Low Low
PRECAUTIONS ARE
Medium Medium Medium
High TAKEN
High High
INSTALLERS WILL BE BRIEFED ON ALL
REQUIREMENTS OF METHOD
STATEMENT AND WILL SIGN THE SHEET
INSTALLER
TO SIGNIFY THIS. ALL INFORMATION INSTALLER ON SITE AND
INSTALLER UNAWARE OF ANY SPECIAL AND
FROM SITE SURVEYS AND INSTALLATION MANAGER
1 REQUIREMENT OR ISSUES BEFORE COMMENCING MEMBERS HIGH LOW LOW
RECOMMENDATIONS WILL BE ISSUED TO PROVIDE ALL
RESULTING IN DAMAGE OR INJURY OF THE
PRIOR TO THE VISIT. IF THERE IS ANY RELEVANT INFORMATION
PUBLIC
DOUBT INSTALLATION SHALL NOT
COMMENCE OR WILL BE STOPPED
IMMEDIATELY
ALL P.P.E IS PROVIDED AND
INSTALLERS INSTRUCTED AND
TRAINED IN ITS USE. ANY DEFECTIVE
OR MISSING EQUIPMENT SHOULD BE
INCORRECT USE OF P.P.E OR EQUIPMENT REPORTED IMMEDIATELY. ALL
2 RESULTING IN INJURY TO INSTALLER
INSTALLER MED LOW LOW
EQUIPMENT SHOULD BE VISUALLY
INSTALLER
INSPECTED PRIOR TO USE, AND
POWER TOOLS SHOULD BE TESTED
PERIODICALLY INLINE WITH COMPANY
POLICY.
INSTALLER TO ERECT BARRIERS
AROUND WORK AREA TO PREVENT
MEMBERS
MEMBERS OF THE PUBLIC APPROACHING THE WORK UNAUTHORISED ACCESS. THIS SHOULD
3 AREA RISKING POSSIBLE TRIP, SLIP OR FALL
OF THE MED LOW LOW
BE BIG ENOUGH TO ALLOW ALL
INSTALLER
PUBLIC
PREPARATION WORK TO BE CARRIED
OUT SAFELY INSIDE THE AREA.
Safe an
Safe and Sound 2011

2. ALL INSTALLERS TRAINED IN MANUAL
HANDLING AND SAFE LIFTING
TECHNIQUES. ANY POLES DEEMED TO
BE A TWO MAN LIFT MUST HAVE
POLES BEING LIFTED FROM THE FLOOR TO BE
INSTALLERS REQUIRED NUMBER OF PEOPLE AND
4 ERECTED, POSSIBLY RESULTING IN MUSCULAR LOW MED LOW
SHOULD NOT BE ATTEMPTED ALONE.
INSTALLER(S)
SKELETAL INJURY
ALL INSTALLATIONS WILL BE PLANNED
WITH THE CORRRECT NUMBER OF
INSTALLERS FOR THE TASK CARRIED
OUT.
ALL INSTALLERS TRAINED IN SAFE
SYSTEM OF WORK FOR POLE
ERECTION .
INSTALLER TO ENSURE HE IS
SATISFIED THERE IS NO DANGER TO
MEMBERS SURROUNDING PEOPLE, BUILDINGS OR
POLES FALLING FROM VERTICAL POSITION DURING
OF THE PROPERTY BEFORE COMMENCING THE
5 INSTALLATION CAUSING INJURY TO PERSONS BELOW
PUBLIC AND
HIGH LOW LOW
OPERATION. AS SOON AS POLE IS
INSTALLER
OR DAMAGE TO PROPERTY
INSTALLERS UPRIGHT THE WASHER AND FULL NUT
MUST BE FITTED TO EACH ROD
IMMEDIATELY AND TIGHTENED. ONCE
ALIGNMENT IS COMPLETED THE
LEVELLING NUTS SHOULD BE FITTED
AND ALL NUTS TIGHTENED.
18. Issued to A N Other 19. Expected completion date
20. All remedial work is complete 21. Senior manager
Signed Date Signed Date
Safe an
Safe and Sound 2011