ADDITIONAL INFORMATION: List any relevant Standards, Regulations, Codes of Practice, policies pertinent to the design and/or safe operation of this plant: YES NO Is this plant required to be registered under the Work Health and Safety Regulations? If YES, is inspection and maintenance information available? If further action is required, to be completed by: NAME: POSITION: DATE: Is the operator of this plant/equipment required to be licenced, certificated or deemed competent? If YES, is relevant documentation available? If further action is required, to be completed by: NAME: POSITION: DATE: Is an operation manual available for this plant/equipment? If further action is required, to be completed by: NAME: POSITION: DATE: *Have you identified any hazardous chemicals used with this plant/equipment? You must risk assess all associated hazardous – chemicals. If YES, please enter document cross-reference details on page 1. If further action is required, to be completed by: NAME: POSITION: DATE: *Have Safe Work Method Statements been developed for this plant/equipment? If YES, please enter document cross-reference details on page 1. If further action is required, to be completed by: NAME: POSITION: DATE: SUMMARY OF RISK: Review the risk measured, and the controls, then please select the relevant risk summary statement: A The assessment reveals that the potential risk to health from the use of the plant is not currently significant B The assessment reveals that the potential risk to health from the use of the plant is significant, however controls are in place that reduce risk to acceptable levels C The assessment reveals that the potential risk to health from the use of the plant is significant. Interim controls are in place to reduce risk to acceptable levels. Approved by Area Supervisor: signature date REVIEW OF CONTROL MEASURES Control measures are effective yes *no (*If no, you must do another Risk Assessment) – Date Reviewed: Signed:
ADDITIONAL INFORMATION: List any relevant Standards, Regulations, Codes of Practice, policies pertinent to the design and/or safe operation of this plant: YES NO Is this plant required to be registered under the Work Health and Safety Regulations? If YES, is inspection and maintenance information available? If further action is required, to be completed by: NAME: POSITION: DATE: Is the operator of this plant/equipment required to be licenced, certificated or deemed competent? If YES, is relevant documentation available? If further action is required, to be completed by: NAME: POSITION: DATE: Is an operation manual available for this plant/equipment? If further action is required, to be completed by: NAME: POSITION: DATE: *Have you identified any hazardous chemicals used with this plant/equipment? – You must risk assess all associated hazardous chemicals. If YES, please enter document cross-reference details on page 1. If further action is required, to be completed by: NAME: POSITION: DATE: *Have Safe Work Method Statements been developed for this plant/equipment? If YES, please enter document cross-reference details on page 1. If further action is required, to be completed by: NAME: POSITION: DATE: SUMMARY OF RISK: Review the risk measured, and the controls, then please select the relevant risk summary statement: A The assessment reveals that the potential risk to health from the use of the plant is not currently significant B The assessment reveals that the potential risk to health from the use of the plant is significant, however controls are in place that reduce risk to acceptable levels C The assessment reveals that the potential risk to health from the use of the plant is significant. Interim controls are in place to reduce risk to acceptable levels. Approved by Area Supervisor: signature date REVIEW OF CONTROL MEASURES Control measures are effective – yes *no (*If no, you must do another Risk Assessment) Date Reviewed: Signed: