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a. General Risk assessment form b. Risk assessment report form example c. Contractors risk assessment example for confined spaces NIB d. Contractors risk assessment example for work on fragile roofs NIB e. Machinery risk assessment example NIB 2. 3. 4. Job safety analysis form Essential elements of a permit-to-work form An example of a set of COSHH assessment forms
a. COSHH 1 - DETAILS OF SUBSTANCES USED OR STORED b. COSHH 2 - ASSESSMENT OF A SUBSTANCE 5. 6. 7. 8. 9. Example of a workstation self-assessment checklist (DSE) Example of a noise assessment record form Example of a workplace inspection report form Workplace inspection checklist Accident/incident report form
10. Manual handling of loads assessment checklist 11. Manual handling risk assessment 12. Example fire safety maintenance checklist NIB 13. Example fire risk assessment record of significant findings 14. Construction inspection report form
No
Main Legal Requirements 1 2 3 4 5 Significant Risks 1 2 3 4 5 Existing Control Measures 1 2 3 4 5 Residual Risk, i.e. after controls are in place. Severity Likelihood Information relevant HSE and trade publications Comments from Line Manager Comments from Risk Assessor Residual risk Consequences
Date
Signed
Date
(d) Contractors risk assessment example for Work on Fragile Roofs example 4
INITIAL RISK ASSESSMENT SIGNIFICANT HAZARDS 1. Falls of persons through materials 2. Access across fragile material 3. 4. 5. 6. 7. 8. ACTION ALREADY TAKEN TO REDUCE THE RISKS: Compliance with: Lifting Operations & Lifting Equipment Regulations. (L O L E R) Provision and Use of Work Equipment Regulations. (P U W E R) Work at Height Regulations 2005 H S E Guidance Booklet HS (G) 33 - Safety in Roof work Construction (Design and Management) Regulations 2007. Planning: Fragile materials will be identified before work begins. In each case, an assessment of risk will be made to provide a safe system of work taking account the work to be done, access/egress requirements and protection of the area beneath the work area. Physical: Suitable means of access will be provided, such as roof ladder, crawling boards, scaffolding, and staging. Where access is possible alongside fragile materials such as roof lights, covers will be provided or the fragile material will be fenced off, catch nets will be provided as appropriate. Barriers and signs will be provided so as to isolate the area below fragile materials while work is in progress. No person is permitted to walk upon suspected fragile materials for any purpose, including access and surveying. Managerial/Supervisory: The role of management is to define a safe work method prior to commencement of work, and to arrange for provision of suitable access equipment and trained personnel as required by the safe system devised. Managers must check risk assessments and method statements supplied by subcontractors and others, including the selfemployed, to ensure that the proposed work method is safe. Training: All operatives must be given specific instructions on the system of work to be used in each case. Selection may be required of operatives who have experience of the work and are physically fit. Risk Re-Assessment Date............................. Site Managers Comments:
Manufacturer Other
Yes No Hazard
Hazards
Operatives
Adjustable guards
Fitted to machine Readily adjustable Prevent Ejection Maintained OK
Area
Lighting OK Stability OK Ventilation OK LEV needed
Action Required
SEVERITY
FREQUEN CY
RISIDUAL RISK F)
(S x
Task steps
Hazards
Consequence /Likelihood
Severity
Risk L X S
Controls
Job Instruction
Training requirements
Review date
2 Permit No
5 Description of Work
6 Hazard Identification
7 Precautions necessary
7 Signatures
8 Protective Equipment
SUBSTANCE DETAILS
1. Information from the label Trade name: Manufacturer's name:.. Names of any chemical constituents listed:. . Hazard marking - whether corrosive, irritant, harmful, toxic, very toxic. .. RISKS Phrases noted on label (e.g. Harmful in contact with skin) ..................................................................................... ............................................................................................................................................... Safety Phrases noted on labels (e.g. avoid contact with skin) ........ ............................................................................................................................................... PRECAUTIONS noted on label (e.g. Use in well ventilated area) ........ . . 2. Have you got a Health & Safety Data Sheet for this product? YES/NO
DETAILS OF USE
3. 4. 5. 6. 7. What it is used for?............................................................................................................. By whom?............................................................................................................................ How often?.......................................................................................................................... Where?................................................................................................................................ What CONTROL measures (precautions) are used? (E.g. local ventilation, goggles, respirator, protective gloves. etc.)..
..... . ....
8. Is it ABSOLUTELY ESSENTIAL to keep/use this substance? 9. Can it be DISPOSED OF NOW? YES/NO YES/NO
The completion of this checklist will enable you to carry out a self-assessment of your own workstation. Your views are essential in order to enable us to achieve our objective of ensuring your comfort and safety at work. Please circle the answer that best describes your opinion, for each of the questions listed. The form should be returned toas soon as it has been completed. Environment 1. Lighting Describe the lighting at your usual workstation. About right Too bright Do you get distracting reflections on your screen? Never Sometimes What control do you have over local lighting? Full control Some control 2. Temperature and humidity At your workstation, is it usually: Comfortable Is the air around your workstation: Comfortable 3. Noise Are you distracted by noise from work equipment? Never Occasionally 4. Space Describe the amount of space around your workstation. Adequate Inadequate Constantly Too dry? Too warm Too cold? Too dark Constantly No control
Furniture 5. Chair Can you adjust the height of the seat? Yes / No Can you adjust the height and angle of the backrest? Yes / No Is the chair stable? Yes / No Does it allow movement? Yes / No
Record (continued) Furniture (continued) Chair (continued) Is the chair in a good state of repair? Yes / No If your chair has arms, do they get in the way? Yes / No 6. Desk Is the desk surface large enough to allow you to place all your equipment where you want it? Yes / No Is the height of the desk suitable? Yes / Too high / Too low Does the desk have a matt surface (non-reflectant)? Yes / No 7. Footrest If you cannot place your feet flat on the floor whilst keying, has a footrest been supplied? Yes / No 8. Document holder If it would be of benefit to use a document holder, has one been supplied? Yes / No If you have a document holder, is it adjustable to suit your needs? Yes / No Display Screen Equipment 9. Display screen Can you easily adjust the brightness and the contrast between the characters on screen and the background? Yes / No Does the screen tilt and swivel freely? Yes / No Is the screen image stable and free from flicker? Yes / No Is the screen at a height, which is comfortable for you? Yes / No 10. Keyboard Is the keyboard separate from the screen? Yes / No
Record (continued) Display Screen Equipment (continued) Keyboard (continued) Can you raise and lower the keyboard height? Yes / No Can you easily see the symbols on the keys? Yes / No Is there enough space to rest your hands in front of the keyboard? Yes / No 11. Software Do you understand how to use the software? Yes / No 12. Training Have you been trained in the use of your workstation? Yes / No Have you been trained in the use of software? Yes / No If you were to have a problem relating to display screen work, would you know the correct procedures to follow? Yes / No Do you understand the arrangements for eye and eyesight tests? Yes / No Any other comments?
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Name of Department:
Lower Exposure Action Level: 80 dBA daily or weekly Workplace Number of Persons Exposed Noise Level (Leq) dB(A)
Date of Survey:
Upper Action Level: 85 dBA daily or weekly Daily Exposure Period LEP'd dB(A) Peak Pressure dB(C) Peak Pressure: 135 dB(C)/137dB(C) Comments
General Comments:
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Date of Inspection
(See Appendix 7.3 Inspection Checklist and Appendix 5.1 for hazard checklist) Observations List hazards, unsafe practices and good practices Priority/ risk (H,M,L) Actions to be taken (if any) List all immediate and longer-term actions required Time Scale Immediate 1 week etc
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Working platforms/ temporary scaffolds Use of mobile elevating work platforms 2 Access Access ways
Cleaning Noise
Ergonomics
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Welfare
Toilets /Washing
Washing and toilet facilities satisfactory? Kept clean, with soap and towels/ Adequate changing facilities Clean and adequate/Means of heating food?
Eating facilities
Rest room
For pregnant or nursing mothers Kept clean? Suitably placed and provisioned? Appointed person? Trained first aider? Correct signs and notices? Eye wash bottles as necessary? Portable equipment tested? Leads tidy not damaged? Fixed installation inspected Equipment serviced annually? Hot and cold water provided? Drinking water provided? In place? Full? Correct type? Maintenance contract? Posted up? Not defaced or damaged? Fitted and tested regularly? Adequate for the numbers involved? Unobstructed? Easily opened? Properly signed?
First aid
Services
Adequate for the numbers involved? Unobstructed? Easily opened? Properly signed?
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Mechanical handling
On site
Forklifts and other trucks properly maintained? Drivers authorized and properly trained? Passengers only where specifically intended with suitable seat? Speeding limits? Following correct route? Properly serviced? Drivers authorized Suitable vehicles used? No use of mobile phones when driving? Properly serviced? Schedules managed properly?
Road risks
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10 Dangerous substances
Stored properly? Used properly/minimum quantities in workplace? Sources of ignition? Correct signs used?
11 Hazardous substances
Chemicals
COSHH assessments OK? Exposures adequately controlled? Data sheet information available? Spillage procedure available? Properly stored and separated as necessary? Properly disposed of?
Exhaust ventilation
PROCEDURES Risk 12 assessments 13 Safe systems of Work 14 Permits to work 15 Personal Protective Equipment 16 Contractors 17 Notices, Signs Employers' and Posters liability
insurance Health and Safety law poster Safety Signs Carried out? General and fire? Suitable and sufficient?
Provided as necessary? Kept up to date/ Followed Used for high risk maintenance? Procedure OK? Properly followed? Correct type? Worn correctly? Good condition? Is their competence checked thoroughly? Are there control rules and procedures? Are they followed? Notice displayed? In date?
Displayed?
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PEOPLE 18 Health surveillance 19 People's behaviour 20 Training and supervision 21 Appropriate authorized person 22 Violence
Specific surveillance required by law? Stress or fatigue? Are behaviour audits carried out? Is behaviour considered in the safety programme? Suitable and sufficient? Induction training? Refresher training? Is there a system for authorizing people for certain special tasks like permits to work, dangerous machinery, entry into confined spaces? Any violence likely in workplace? Is it controlled? Are there policies in place Young persons New or expectant mothers Employed? Special risk assessments? Employed? Special risk assessments?
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9 - ACCIDENT/INCIDENT REPORT
INJURED PERSON: .Date of Accident: ...../.... /20 Time.am/pm
POSITION: Place of Accident: . DEPARTMENT: Details of Injury: .... Investigation carried out by: .............................. Position: .. Estimated Absence: ..............
Brief details of Accident (A detailed report together with diagrams, photographs and any witness statements
should be attached where necessary. Please complete all details requested overleaf.)
Immediate Causes
Action to be taken: Completion Date:.... /....../20 Please ensure that an accident investigation and report is completed and forwarded to Personnel within 48 hours of the accident occurring. Remember that accidents involving major injuries or dangerous occurrences have to be notified immediately by telephone to the local authority. Signature of Manager making Report: Copies: Date:...../...... /20 INJURED PERSON: Personnel Manager Health & Safety Manager Payroll Controller
Surname ........Forenames .............. Male/Female Home address ............................ Age Consent to share this information with Safety Representatives Signature of Injured Person............................................Date......./....../.....20... Agency Temp Contractor Visitor Youth Trainee (Tick one box)
Employee
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Kind of Accident Contact with moving machinery or material being machined Struck by moving including flying, or falling object Struck by moving vehicle Struck against something fixed or stationary
Indicate what kind of accident led to the injury or condition (tick one box) Injured whilst handling lifting or Drowning or asphyxiation Contact with electricity or an electrical discharge
1
Slip, trip or fall on same level
9
Exposure to or Injured by an animal contact with harmful
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2
Fall from height
6
Exposure to fire
10
Violence
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3 indicate approx.
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15
4 collapsing or overturning 8
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Accident first reported to: Name .. Position & Dept.. First Aid/medical attention by: First Aider Name Dept . Doctor Name ............................................... Medical centre Hospital. WITNESSES Name For Office use only If relevant: Date reported to Enforcing Authority a) by telephone ..../.../20 b) by internet ..../....../20 c) on form F2508 ./../20 ../../20 Position & Dept . . . . Statement obtained (yes/no) Attach all statements taken yes/no yes/no yes/no yes/no
Were the Recommendations Effective? If No say what further action should be taken.
Yes/No
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If YES continue. If NO the assessment need go no further. Tasks covered by this assessment (detailed description): Locations: People involved: Date of assessment: Section B See separate sheet for detailed analysis Section C Overall assessment of the risk of injury? Section D Remedial action needed: Remedial steps that should be taken, in priority order: a b c d e f g h Date by which action should be taken: Date for reassessment: Assessors name: Signature: Low / Medium / High Diagrams and other information:
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Employees ID No
Yes/No
Risk Level H M L
Current Controls
10. Insufficient periods of rest/recovery? 11. High work rate imposed? B. load characteristics 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. 1. 2. 3. 4. Heavy? Bulky? Difficult to grasp? Unstable/unpredictable? Harmful (sharp/hot)? Postural constraints? Floor suitability? Even surface? Thermal/humidity suitability? Lighting suitability? Unusual capability required? Hazard to those with health problems? Hazard to pregnant workers? Special information/training required?
D. Individual characteristics
Yes/No
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Yes No Daily Checks (not normally recorded) Escape Routes Can all fire exits be opened immediately and easily? Are fire doors clear of obstructions? Are escape routes clear? Fire warning systems Is the indicator panel showing normal? Are whistles, gongs or air horns in place? Escape lighting Are luminaries and exit signs in good condition and undamaged? Is emergency lighting and sign lighting working correctly? Firefighting equipment Are all fire extinguishers in place? Are fire extinguishers clearly visible? Are vehicles blocking fire hydrants or access to them? Weekly checks Escape routes
N/A Comments
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Yes No Do all emergency fastening devices to fire exits (push bars and pads, etc.) work correctly? Are external routes clear and safe? Weekly checks continued Fire warning systems Does testing a manual call point send a signal to the indicator panel? (Disconnect the link to the receiving centre or tell them you are doing a test.) Did the alarm system work correctly when tested? Did staff and other people hear the fire alarm? Did any linked fire protection systems operate correctly? (e.g. magnetic door holder released, smoke curtains drop) Do all visual alarms and/or vibrating alarms and pagers (as applicable) work? Do voice alarm systems work correctly? Was the message understood? Escape lighting Are charging indicators (if fitted) visible? Firefighting equipment Is all equipment in good condition? Additional items from manufacturers recommendations. Monthly checks Escape routes Do all electronic release mechanisms on escape doors work correctly? Do they fail safe in the open position? Do all automatic opening doors on escape routes fail safe in the open position? Are fire door seals and self-closing devices in good condition? Do all roller shutters provided for fire compartmentation work correctly? Are external escape stairs safe? Do all internal self-closing fire doors work correctly? Escape lighting Do all luminaries and exit signs function correctly when tested? Have all emergency generators been tested? (Normally run for one hour.) Fire fighting equipment Is the pressure in stored pressure fire extinguishers correct?
N/A Comments
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N/A Comments
Three-monthly checks General Are any emergency water tanks/ponds at their normal capacity? Are vehicles blocking fire hydrants or access to them? Additional items from manufacturers recommendations. Six-monthly checks General Has any fire fighting or emergency evacuation lift been tested by a competent person? Has any sprinkler system been tested by a competent person? Have the release and closing mechanisms of any fire-resisting compartment doors and shutters been tested by a competent person? Fire warning system Has the system been checked by a competent person? Escape lighting Do all luminaries operate on test for one third of their rated value? Additional items from manufacturers recommendations. Annual checks Escape routes Do all self-closing fire doors fit correctly? Is escape route compartmentation in good repair? Escape lighting Do all luminaries operate on test for their full rated duration? Has the system been checked by a competent person? Fire fighting equipment Has all fire fighting equipment been checked by a competent person? Miscellaneous Has any dry/wet rising fire main been tested by a competent person?
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Yes No Has the smoke and heat ventilation system been tested by a competent person? Miscellaneous continued Has external access for the fire service been checked for ongoing availability? Have any fire-fighters switches been tested? Has the fire hydrant bypass flow valve control been tested by a competent person? Are any necessary fire engine direction signs in place?
N/A Comments
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Sources of fuel
Sources of oxygen
Step 3 Evaluate, remove, reduce and protect from risk (3.1) Evaluate the risk of the fire occurring (3.2) Evaluate the risk to people from a fire starting in the premises (3.3) Remove and reduce the hazards that may cause a fire (3.4) Remove and reduce the risks to people from a fire Assessment review Assessment review date
Completed by
Signature
Review outcome (where substantial changes have occurred a new record sheet should be used)
(1) The risk assessment record of significant findings should refer to other plans, records or other documents as necessary. (2) The information in this record should assist you to develop an emergency plan; coordinate measures with other responsible persons in the building; and to inform and train staff and inform other relevant persons.
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2. Site address.
Yes / No
10. Name and position of person making the report. 11. Date and time report handed over. 12. Name and position of person receiving report.
94 I Safety at work
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