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    Risk Assessment Form: Department of Mechanical Engineering

    Uploaded by

    Amy Leigh Williams
    This risk assessment form requires information about a project activity including: - A description of the activity and location it will take place - Names of those involved and potential risks/consequences - Use of hazardous materials, mains electricity, or pressurized equipment - Required precautions, personal protective equipment, shutdown procedures, and emergency responses The student and supervisor must declare awareness of risks and approval for the activity. The area safety warden determines supervision levels and approves the activity to proceed.

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    Download as DOCX, PDF, TXT or read online from Scribd

    Risk Assessment Form: Department of Mechanical Engineering

    Uploaded by

    Amy Leigh Williams
    201 views2 pages
    This risk assessment form requires information about a project activity including: - A description of the activity and location it will take place - Names of those involved and potential risks/consequences - Use of hazardous materials, mains electricity, or pressurized equipment - Required precautions, personal protective equipment, shutdown procedures, and emergency responses The student and supervisor must declare awareness of risks and approval for the activity. The area safety warden determines supervision levels and approves the activity to proceed.

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    Risk+Assessment+Form+2015

    Original Title

    Risk+Assessment+Form+2015

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    This risk assessment form requires information about a project activity including: - A description of the activity and location it will take place - Names of those involved and potential risks/consequences - Use of hazardous materials, mains electricity, or pressurized equipment - Required precautions, personal protective equipment, shutdown procedures, and emergency responses The student and supervisor must declare awareness of risks and approval for the activity. The area safety warden determines supervision levels and approves the activity to proceed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    201 views2 pages

    Risk Assessment Form: Department of Mechanical Engineering

    Uploaded by

    Amy Leigh Williams
    This risk assessment form requires information about a project activity including: - A description of the activity and location it will take place - Names of those involved and potential risks/consequences - Use of hazardous materials, mains electricity, or pressurized equipment - Required precautions, personal protective equipment, shutdown procedures, and emergency responses The student and supervisor must declare awareness of risks and approval for the activity. The area safety warden determines supervision levels and approves the activity to proceed.

    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 2

    Department of Mechanical Engineering

    Risk Assessment Form

    Risk Assessments are not required for simple workshop activities covered by the Safety Declaration.
    However permission must be obtained from Mr Glen Newins before commencing any activity in the
    Workshop.
    A new Risk Assessment form needs to be completed for each major activity within your project.
    You are required to include this document (signed) in your bound project submission and mount a
    copy next to any rig / apparatus you are using.

    Your Name
    Your Supervisor
    Project title and
    number
    Area Safety Warden
    This Section to be completed by the student (Must be typed and the declaration signed)
    Location where the activity will be
    done
    Describe the activity
    (use attachment with diagrams if
    needed)
    Names of persons involved in this
    activity
    Describe in detail the risks you (and
    others) will face during this activity
    and the potential consequences of
    your activities
    Does your project involve the use of
    any materials (chemicals, gasses,
    etc.) which may be hazardous to
    health, or the environment
    Does this activity involve any
    equipment / device designed or built
    by you which is to be plugged into
    mains electricity?
    Does your project involve any new
    equipment / devices designed which
    contain gas or volatile liquids at
    pressure?
    What precautions are required to
    protect against the risks detailed
    above?
    Describe the personal protective
    equipment (PPE) required during this
    activity specify in detail.
    Describe the shutdown procedure in
    detail.

    N
    o

    Ye
    s

    If Yes list the chemicals / gasses to be used and attach the MSDS(s)
    for these materials.

    N
    o

    Ye
    s

    If Yes please consult with Mr Julian Mayer before connecting to the


    mains / switching on.

    N
    o

    Ye
    s

    If Yes please check the relevant SANS Pressurised Equipment


    Regulations and consult with Dr Fuls before design, build or test.

    Describe any relevant emergency


    procedures, e.g. spillage response
    etc.
    I declare that I am aware of the risks
    associated with this activity and will
    take all necessary steps to mitigate
    these risks.

    Student Signature

    Date

    I am aware of the students intended


    activity, and have provided the
    necessary guidance, inputs, and
    oversight.

    Supervisor Signature

    Date

    This section to be completed by the Area Safety Warden


    Level of supervision required
    A = work may not take place without supervisor/warden
    (Please tick relevant block)
    present.
    B = work may not take place without a 2nd party present.
    C = no specific extra supervision requirements.

    I am satisfied that the student is


    aware of the risks associated with
    this activity and grant approval for
    it to proceed.

    Signature

    Date

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