COMPANY

SITE

Location / Machine / Operation

Function / Persons at risk – Summary

Hazard Analysis – Identify

1 TRIPPING OVER POWER LEADS AND HAND TOOLS

2 DROPPING OF UN-INSTALLED GRIPFAST®

3 DUST CREATED BY TRIMMING OVERSIZED TREADS

Hazard Rating (Probable Frequency x Severity) 2 X 2 = 4

Existing Control Measures – Identify

1 KEEP ALL POWER LEADS + POWER TOOLS TO SIDE OF WALKWAYS

2 FOLLOW S W P

3 USE CORRECT P P E

Risk Rating (Hazard Rating x Control Rating) 4 X 0.5

Actions / Control Measures Required

FOLLOW S W P AT ALL TIMES

RESTRICT ACCESS WHERE POSSIBLE TO GRIPFAST® EMPLOYEES ONLY. ADHERE TO CLIENTS= SAFETY PROCEDURES

AT ALL TIMES.

Amended / Final Risk Rating 2

ASSESSED BY DATE

HAZARD RATING

Probable Frequency Severity

1 Improbable Occurrence 1 Trivial Injury

2 Possible Occurrence 2 Minor Injury

3 Occasional Occurrence 3 Over 3-day Injury

4 Frequent Occurrence 4 Major Injury

5 Common Occurrence 5 Death

CONTROL RATING

0 Completely Foolproof

0.25 Complete Protection

0.5 Protection with SWP / PPE

0.75 Safe Working Practice

1 No Protection

RISK RATING

0 - 5 Satisfactory

5 - 15 Action Necessary

15 - 26Immediate Action Required