RA No.: Date: Version No.: Activity Title: SECTION 1: GENERAL INFORMATION Campus location: Bldg. / level / room College: School / Discipline / Facility: Person undertaking the activity / Position: Supervisor / Position: Lists the main steps in the activity (add more lines as required). Are any of the following licenses / permits required: Step # Description Poisons permit covering scheduled drugs / poisons (S4/S7/S8/S9/S10) Confined space entry permit 1 Licence for using radiation sources or Genetic Modified Material 2 Animal Ethics / Human Ethics approval Other : specify - 3 4 If any boxes are checked, specify the applicable permit or licence number: 5 Use the list below to assist in identifying hazards that may be encountered in each step. You must consider all hazards, some of which may not be included in this list. All identified hazards must then be included in Section 4 and controls listed in Section 5. Animals / Insects Biological materials (e.g. Confined spaces Hazardous chemicals Plant / equipment bacteria, viruses) Electrical Fumes / vapours / dust Manual Handling (lifting, Repetitive movements, High pressure / vacuum pushing, moving objects) awkward postures Extreme temperatures Vibration Trip / slip hazards / uneven Mechanical (rotating parts, Working at heights or ground or work surface crush / pinch points) (High / Low) below ground level (e.g. excavations) Interaction with public Overhead power lines Working in isolation Noise Interaction with public (threat to security) (threat to safety) Other (Specify): Lasers Traffic hazards (vehicles, Gases Radiation (including UV) forklifts, aircraft, drones) NOTE: If the activity involves the use of radiation / biohazards / lasers you must complete a separate risk assessment form designed specifically to address these hazard – types.
RA No.: Date: Version No.: Activity Title: SECTION 1: GENERAL INFORMATION Campus location: Bldg. / level / room College: School / Discipline / Facility: Person undertaking the activity / Position: Supervisor / Position: Lists the main steps in the activity (add more lines as required). Step # Description Are any of the following licenses / permits required: Poisons permit covering scheduled drugs / poisons (S4/S7/S8/S9/S10) Confined space entry permit Licence for using radiation sources or Genetic Modified Material Animal Ethics / Human Ethics approval Other : specify - If any boxes are checked, specify the applicable permit or licence number: 1 2 3 4 5 Use the list below to assist in identifying hazards that may be encountered in each step. You must consider all hazards, some of which may not be included in this list. All identified hazards must then be included in Section 4 and controls listed in Section 5. Plant / equipment Animals / Insects Biological materials (e.g. bacteria, viruses) Confined spaces Hazardous chemicals High pressure / vacuum Electrical Fumes / vapours / dust Manual Handling (lifting, pushing, moving objects) Repetitive movements, awkward postures Mechanical (rotating parts, crush / pinch points) Vibration Trip / slip hazards / uneven ground or work surface Extreme temperatures (High / Low) Working at heights or below ground level (e.g. excavations) Interaction with public (threat to safety) Interaction with public (threat to security) Overhead power lines Working in isolation Noise Radiation (including UV) Lasers Traffic hazards (vehicles, forklifts, aircraft, drones) Gases Other (Specify): NOTE: If the activity involves the use of radiation / biohazards / lasers – you must complete a separate risk assessment form designed specifically to address these hazard types.
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