RISK ASSESSMENT FORM

Contractor: Contract: Contractors Representative: Telephone: Signature: Fax: Date: Signature: Date: Council Representative: Contract No: Telephone: Fax:

Specific Task/Activity

Potential Class Hazards/Consequences of Risk*

Control Measures
(Include reference to legislation, codes and standards)

Note* Class 1 = Potential to cause death or permanent injury to one or more people; injuries; Class 3 = Potential to cause an injury treatable with first aid

Class 2 = Potential to cause one or more lost time

COMPLETED SAMPLE RISK ASSESSMENT Example 1

Contractor: ACME Road Repair Pty Ltd Contract: Repair of Pot Holes in Road North Hwy b/w Johns Road and Smith Street turn off Contractors Representative: John Smith Telephone: Signature: 9834 2222 Fax: 9834 2221 Date: 30 November 1996 Signature: Date: 15 December 1996 Council Representative: : Contract No: LC-459-08 Telephone: : 9350 8383 Fax: 9750 8384 Fred Johnston

Specific Task/Activity
Occupation of work site Set up, during works, and final inspections

Potential Class Control Measures Hazards/Consequences of Risk (Include reference to legislation, codes and standards)
Public vehicles hitting workers or equipment 1 Safety signage and traffic control procedures will conform with applicable regulations and codes of practice to ensure adequate safety and minimise inconvenience to traffic. This will include the use of safety signage (Beware Road Works Ahead) at least 500m before work area. Witches hats to divide off one lane. Plan work so that one side of road is repaired at a time. Flag men at either end of work area slowing traffic and communicating via hand held radios so that one way traffic is permitted in opposite lane. Wearing of bright reflective safety jackets by workmen. Refer company safe work procedure SWP06: Traffic Management. Wearing of safety footwear. Provide training in safe use of equipment prior to operation. Two-man lifts to lift and lower compactor from truck. Employees to wear hearing protectors when operating plant.

Operation of plant compactor (whacker)

Crushing of feet Manual handling resulting in strain/back injury

2 2 2

Operation of plant compactor / jackhammer

Noise exposure

Specific Task/Activity
Operation of plant compressor

Potential Class Control Measures Hazards/Consequences of Risk (Include reference to legislation, codes and standards)
Contact with high pressure Noise exposure 2 3 2 1 3 3 Hose couplings fitted with pins or chains. Hoses, couplings inspected as part of daily plant inspection. Noise control equipment fitted to compressor. No smoking, handling of fuels in well ventilated areas, fire extinguishers on hand, wearing of eye protection. Proper use of ropes, chain and straps to adequately secure equipment on vehicle. Use of protective clothing (gloves, overalls), ensure good hygiene and washing before lunch and at end of day. Wearing of suitable clothing, hats and provision of sun cream. Employees will be supplied with protective gloves and hard hats supervised by foreman. Daily safety inspection to be conducted by supervisor and foreman. Class 2 = Potential to cause one or more lost time

Handling and decanting fuels for compressor Transport of equipment Handling of hot tar Outside work exposure to weather General

Fire, eye splashes Equipment falling from truck causing traffic accidents Heat and chemical exposure Sunburn General

Note* Class 1 = Potential to cause death or permanent injury to one or more people; injuries; Class 3 = Potential to cause an injury treatable with first aid

COMPLETED SAMPLE RISK ASSESSMENT FORM Example 2

Contractor: ABC Services Pty Ltd Contract: Aged & Disability Services Contractors Representative: Joanne Smith Telephone: Signature: 9834 2222 Fax: 9834 2232 Date: 30 November 1996 Signature: Date: 6 December 1996 Council Representative: Fred Johnston Contract No: : Telephone: LC-460-07 9350 8383 Fax: : 9750 8384

Specific Task/Activity

Potential Class Hazards/Consequences of Risk

Manual handling causing injury to client Manual handling resulting in strain / back injury Contact with electricity faulty leads/appliances 1 to 2 2 1

Control Measures
(Include reference to legislation, codes and standards)
Employees to use appropriate transfer aids provided (transfer belts, swivel seats in cars) Training provided on safe transfer techniques and methods Pre-inspection assessment of household to review condition of leads, appliances. Provision and use of portable electrical safety switches. Training on safe work methods (refer company safe work procedure SWP01: Electrical safety).

Transfer of aged and disabled persons (from vehicles, baths, beds etc) Operation of electrical appliances

Use of cleaning chemicals

Exposure contact

to

fumes

and

skin

Employees provided with list of prohibited cleaning products. Employees to wear personal protective equipment (rubber gloves, plastic aprons).

Vacuuming, sweeping and mopping

Manual handling resulting in strain /

Training provided on safe cleaning methods.

Specific Task/Activity

Potential Class Hazards/Consequences of Risk

back injury;

Control Measures
(Include reference to legislation, codes and standards)

Techniques focus on minimising lifting and bending. Slips / falls Bathing activities Laundry operations Manual handling resulting in strain / back injury Manual handling resulting in overuse injury, strain injury Broad range of potential hazards 2 Ensure that appropriate footwear is used (rubber soled shoes). 2 2 Training provided on safe bathing techniques and aids which can be used. Provide laundry trolley where appropriate. Training provided on safe work method. 13 Assessment undertaken of household for safety risks and remedial action undertaken where necessary. Standard safety inspection checklist used (refer checklist CH-02). Employees advised of any particular safety risk issue in household and methods to control risks. Personal care Client aggression (e.g.biting, scratching) resulting in bodily harm. 13 Employees provided with behaviour management training. Appropriate service plans prepared for each client. Class 2 = Potential to cause one or more lost time

General conditions of client household

Note* Class 1 = Potential to cause death or permanent injury to one or more people; injuries; Class 3 = Potential to cause an injury treatable with first aid