No: DEE ESWB-10-2-2

Authorised By: Manager ESWB

Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 1 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

1. Hazard Management Details – General

Plant/Equipment Item: FORKLIFT (Fuel) Make/Model No.: Serial No.:

School / Work Location: Region:

Name of Person(s) Conducting Activity: Date Conducted:

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 2 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

INCLUDEPICTURE Description: Summary of Key Risks:

"http://image.made-in-china.com/2f0j00ieqtkmREbWoC/3- A forklift is a motorised vehicle which uses  Entanglement
5ton-Lpg-Forklift-CPQD35-.jpg" \* MERGEFORMATINET power operated prongs/tines to lift and
 Impact and cutting
INCLUDEPICTURE move heavy loads.
"http://image.made-in-china.com/2f0j00ieqtkmREbWoC/3-  Shearing
5ton-Lpg-Forklift-CPQD35-.jpg" \* MERGEFORMATINET  Electricity
INCLUDEPICTURE  Ergonomics
"http://image.made-in-china.com/2f0j00ieqtkmREbWoC/3-
5ton-Lpg-Forklift-CPQD35-.jpg" \* MERGEFORMATINET  Noise
INCLUDEPICTURE  Vibration
"http://image.made-in-china.com/2f0j00ieqtkmREbWoC/3-  Slips/trips/falls
5ton-Lpg-Forklift-CPQD35-.jpg" \* MERGEFORMATINET
 Fire and explosion
 Other (exhaust fumes)

2. Documentation

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 3 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Relevant Legislation/Standards Y/N Comments

Is plant required to be registered? Y N If to be driven on any public thoroughfare

Is a user licence required? Y N Operators must have an appropriate forklift licence

Key reference material: AS 2359.1 Powered Industrial Trucks – General requirements

WorkSafe Victoria Guidance Note: “Forklift Safety, Reducing the Risk.”
AS 4983 Gas fuel systems for forklifts and industrial engines
Plant Documentation Y/N Comments
Are operator’s manuals accessible? Y N Operators manual should be supplied on purchase of the vehicle

Is this a restricted use item? Y N Operators must have an appropriate forklift licence

Does this item require safe use documents/test? Y N Operators must have an appropriate forklift licence

3. Hazard Identification

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level
ENTANGLEMENT Major Rare Medium Loose clothing, long hair, Ensure clothing, gloves, hair or
Can anyone’s hair, clothing, gloves, cleaning brushes, gloves, body parts and other other such items are kept clear of
tools, rags or other materials become entangled with material may become entangled moving parts of the forklift when
moving parts of the plant or materials? in moving parts of the forklift operating or performing
(e.g. chain mast). maintenance (e.g. overalls can be
Y N used to restrict loose clothing etc).

Remove or secure any packaging

that may become entangled in the
chain mast.

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 4 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level
IMPACT AND CUTTING INJURIES Materials could fall from the Ensure only licensed persons
Can anyone be crushed/cut/struck etc. due to: tines of the forklift or pallet operate the forklift and have been
 Material falling off the plant? Major Possible High whilst in operation if not trained in safe work practices.
Y N appropriately secured.
 Uncontrolled/unexpected movement of plant/load? Y N Major Rare Medium Ensure the forklift is only operated
 Lack of capacity to slow, stop or immobilize plant? Severe Rare Medium Forklift could rollover if the load on appropriate surfaces (i.e. level
Y N is unbalanced, operated on an ground) and a seatbelt is worn at
 The plant tipping or rolling over? Y N Severe Rare Medium uneven surface or traversing a all times.
slope.
 Parts of the plant disintegrating or collapsing? Y N Severe Rare Medium
Ensure the load is within the
 Contact with moving parts during testing, Major Rare Medium The mobility of the forklift poses forklifts lifting capacity and is
inspection, operation, maintenance, cleaning or Y N a significant risk to pedestrians appropriately secured before lifting
repair? and property. and moving.
 Being thrown off or under the plant? Y N Severe Rare Medium
Use of inappropriate parts could Ensure the forklift is serviced or
 Contact with sharp or flying objects? (e.g. work
Y N lead to mechanical failure. repaired by a qualified person and
pieces being ejected)
only manufacturer recommended
 The mobility of the plant? Y N Severe Rare Medium
parts and accessories are used.
Operator error (e.g. poor
 Inappropriate parts and accessories being used? Y N Severe Rare Medium visibility, fatigue etc) may lead
to an accident. (Cont.…)
 Other Ensure appropriate traffic
. management controls have been
implemented. For example:
Y N  Designated and marked
pedestrian paths (e.g. painted
walkways, bollards/fenced
walkways etc)

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 5 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

 Pedestrian no go zones
 High visibility clothing is worn by
operator/persons in the work
area
 Signs and barricades to be
installed to warn other
employees/persons in area
 A documented Traffic
Management Plan is in place
 Relevant employees have
attended traffic management
training

Ensure forklift is fitted with

appropriate safety features. For
example:
 ‘Dead Man’s’ control/emergency
stop
 Park brake
 Seatbelt
 Rollbar/cage
 Reversing alarm

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 6 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

SHEARING Severe Rare Medium Forklift/pedestrian interaction Establish a Traffic Management

Can anyone’s body parts be sheared between two could lead to a person being Plan.
parts of plant, or between a part of the plant and a trapped between the forklift and
work piece or structure? Y N another object. Ensure appropriate traffic
management controls are in place
(refer to cutting and impact injuries
section).
PRESSURISED CONTENT
Can anyone come into contact with fluids or gases
Y N
under high pressure, due to plant failure or misuse of
the plant?
ELECTRICITY Overhead power lines or Operator to check area for any
Can anyone be injured or burnt due to: electric wires pose a significant potential hazards.
 Live electrical conductors? (e.g. exposed wires) Severe Rare Medium risk to the operator.
Y N
Ensure the forklift is not operated
 Working in close proximity to electrical in close proximity to overhead
Y N power lines or electrical wiring.
conductors?
 Access to electricity?
Y N

 Damaged or poorly maintained electrical leads,

Y N
cables or switches?
 Water near electrical equipment?
Y N

 Lack of isolation procedures?

Y N

 Other
Y N

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 7 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level
ERGONOMICS Operating the forklift for Ensure the forklift is not operated
Can anyone be injured due to: extended periods of time or for extended periods of time.
 Poorly designed workstation? Moderate Possible Medium poorly designed or degraded
Y N seats may cause Ensure appropriate rest breaks are
musculoskeletal injury. taken.
 Repetitive body movement? Moderate Possible Medium
Y N

 Constrained body posture or the need for Ensure forklift seating is in good
Y N condition and can be adjusted for
excessive effort?
different body types.
 Design deficiency causing psychological stress?
Y N

 Inadequate or poorly placed lighting?

Y N

 Does the plant impact on the surrounding

workplace and create potential hazards? Y N
(Consider safe access and egress from plant,
workflow and design of the workplace)
 Is the location of the plant inappropriate?
(Consider potential effects due to environmental Y N
conditions and terrain)
 Other
Y N

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 8 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level
RADIATION
Can anyone using the plant, or in the vicinity of the
plant suffer injury or illness due to exposure to
radiation in the form of any of the following: Y N
 infra-red radiation
 ultra violet light
 microwaves
NOISE Moderate Unlikely Medium Operation of the forklift could Appropriate hearing protection
Can anyone using the plant, or in the vicinity of the Y N result in high noise levels. should be worn whilst operating
plant, suffer injury due to exposure to noise? the equipment (if required).
VIBRATION Moderate Unlikely Medium The operator of the forklift could
Can anyone be injured or suffer ill-health from suffer from Whole Body Take regular breaks from
exposure to vibration? Vibration (WBV) as a result of continuous operation.
vibration generated by the
Y N forklift. Conduct periodic maintenance of
the forklift for smooth operation
and to reduce vibration.

FRICTION
Can anyone be burnt due to contact with moving Y N
parts, materials or surfaces of the plant?
SUFFOCATION
Can anyone be suffocated due to lack of oxygen, or Y N
atmospheric contamination?

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 9 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

CONDITION
Is a hazard likely due to the age and condition of the
Y N
plant? (Consider how hard the machine has been
worked, and whether it is used constantly or rarely).
 Can anyone be injured as a result of the plant not
serviced appropriately and/or maintained in line Y N
with manufacturer’s recommendations?

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level
SLIPS/TRIPS/FALLS Access and egress to the forklift Ensure operator wears slip
Can anyone using the plant, or in the vicinity of the could pose a risk of slip, trip or resistant footwear to reduce risk of
plant, slip, trip or fall due to: fall. slips/falls.
 Uneven, slippery or steep work surfaces? Major Rare Medium
Y N
Poor housekeeping could result Ensure operator maintains three
 Poor housekeeping, e.g. spillage in the vicinity? Moderate Possible Medium in a slip, trip or fall hazard. points of contact when accessing
Y N or exiting the vehicle.
 Obstacles being placed in the vicinity of the plant? Moderate Possible Medium
Y N
Ensure good housekeeping
 Inappropriate or poorly maintained floor or walking Major Rare Medium practices are maintained
surfaces (i.e. lack of a slip-resistant surface, Y N throughout the work area.
unprotected holes, penetrations or gaps?)
If operating or maintaining plant at height can anyone
slip, trip or fall due to:
 Use of work platforms, stairs or ladders?
Y N

 Lack of guardrails or other suitable edge

Y N
protection?

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 10 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

 Other
Y N

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level
FIRE AND EXPLOSION Major Rare Medium Inappropriate storage and Ensure fuel is appropriately stored
Can anyone be injured by fire? Y N
handling of fuel (e.g. LPG, (e.g. locked storage area).
 Can anyone be injured by explosion of gases, Major Rare Medium diesel) poses a risk of fire and
vapours, liquids, dusts, or other substances? explosion to the operator. Ensure refuelling is conducted in a
safe manner (e.g. equipment is
Y N
switched off, away from ignition
sources, in well-ventilated area
etc).
TEMPERATURE/MOISTURE
Can anyone come into contact with objects at high or Y N
low temperatures?
 Can anyone suffer ill-health due to exposure to
Y N
high or low temperatures?
 Can anyone be injured or suffer ill-health due to
Y N
exposure to moisture?
OTHER Exhaust fumes can be toxic if Ensure the forklift is not operated
Can anyone be injured or suffer ill-health from allowed to accumulate in an in an enclosed space.
exposure to: enclosed space.
 Chemicals? Y N Ensure the forklift is refuelled in a
well-ventilated space.
 Toxic gases or vapours? Y N
 Fumes/Dusts? Y N Moderate Rare Low

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED

 No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: July 2010 Page Number: 11 of 11
Last Reviewed: January 2015 CENTRAL OFFICE USE ONLY
Next Reviewed: May 2015

Hazards Inspected Risk Assessment Description of Risk Control Measures

 Other? (please specify) Y N

4. Risk Assessment Signoff

Authorised By: Signature: Date:

THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED