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    Risk Assessment Template

    Uploaded by

    Malefane Cortez Tlatlane
    The document appears to be a risk assessment template containing sections for listing potential hazards, required safety measures, personal protective equipment, risk level determination and mitigation controls. It includes tables for detailing specific activities, associated hazards, risks, and responsible personnel.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Risk Assessment Template

    Uploaded by

    Malefane Cortez Tlatlane
    21 views2 pages
    The document appears to be a risk assessment template containing sections for listing potential hazards, required safety measures, personal protective equipment, risk level determination and mitigation controls. It includes tables for detailing specific activities, associated hazards, risks, and responsible personnel.

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    Risk assessment Template

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    The document appears to be a risk assessment template containing sections for listing potential hazards, required safety measures, personal protective equipment, risk level determination and mitigation controls. It includes tables for detailing specific activities, associated hazards, risks, and responsible personnel.

    Copyright:

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

    Risk Assessment Template

    Uploaded by

    Malefane Cortez Tlatlane
    The document appears to be a risk assessment template containing sections for listing potential hazards, required safety measures, personal protective equipment, risk level determination and mitigation controls. It includes tables for detailing specific activities, associated hazards, risks, and responsible personnel.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    RISK ASSESSMENT

    RA No.
    ACTIVITY:
    DATE

    LOCATION: PROJECT/DEPARTMENT

    EQUIPMENT TO BE USED SUBSTANCES TO BE USED REVISION STATUS


    REVISION NUMBER REVISED DATE

    POTENTIAL HAZARDS / CONDITIONS CONSIDERED (TICK BOX) PERSONS AT RISK (TICK BOX)

    FALL FROM HEIGHT ELECTRICITY DEEP EXCAVATION EMPLOYEES PUBLIC

    MANUAL HANDLING SLIPS / TRIPPING


    FALLING OF MATERIALS
    SUBCONTRACTORS
    COSHH ENVIRONMENTAL RISK
    LIFTING OPERATION
    ADVERSE WEATHER GENERAL PUBLIC VISITORS
    FIRE RISK
    MANDATORY HSE REQUIREMENTS (TICK BOX)
    SAFETY INDUCTION WORK PERMIT

    TOOL BOX TALK PROPER TOOLS / EQUIPMENTS

    PROPER PPE PROPER SUPERVISION

    SAFE WORK PLACE PROPER BARRICADE AND WARNING SIGN IN THE AFFECTED AREA

    PERSONAL PROTECTIVE EQUIPMENT (PPE) REQUIREMENT (TICK BOX)

    SAFETY HELMET GLOVES EAR PLUGS / DEFENDERS

    SAFETY BOOTS MASK RESPIRATORY / BREATHING APPARATUS

    GOGGLES / SPECTACLE OVERALLS FULL BODY SAFETY HARNESS

    TO REFER OTHER RISK ASSESSMENTS


    1.
    2.
    3.
    RISK LEVEL

    H (HIGH-Potential to cause death or permanent injury) M (MEDIUM – Potential to cause loss time injury) L (LOW – An injury treatable with First Aid)

    LIKELIHOOD (L) SEVERITY (S) CLASS OF RISK (L X S) RISK MATRIX


    5 5 10 15 20 25
    LIKELIHOOD

    1. IMPROBABLE. 1. NEGLIGIBLE.
    HIGH = 15 – 25 4 4 8 12 16 20
    2. REMOTE. 2. MINOR.
    3 3 6 9 12 15
    3. PROBABLE 3. REPORTABLE. MEDIUM = 07 – 14
    2 2 4 6 8 10
    4. OCCASIONAL. 4. SERIOUS. LOW = 01 - 06
    1 1 2 3 4 5
    5. FREQUENT 5. CATASTROPHIC.
    1 2 3 4 5
    SEVERITY (S)

    Write activity name here – Risk Assessment Page | 1


    RISK ASSESSMENT
    RA No:
    WRITE ACTIVITY NAME HERE
    S. Responsible
    Activity Hazard Risk LXS L M H Control measures Residual risk
    N. Person

    01 

    02 

    03 
    Conducted by SIGNATURE: Date

    …………………………………………………………………………………..
    Approved by SIGNATURE: Date

    …………………………………………………………………………………..

    Write activity name here – Risk Assessment Page | 2

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