Source: XpertHR P&D Date: 19/07/2004 Publisher: XpertHR

Health and safety: Work equipment assessment record (form)

TOPICS:
health and safety  law and codes of practice
plant, machinery and equipment

AUTHOR: David Pratt


This form is provided by RSK ENSR Health & Safety Ltd.

Form wording:

Assessment reference number  
Work equipment description  
Location  
Work activity  

(1) Mechanical hazards to persons (Tick box for each applicable)
Hazard type   Notes
Cutting hazard (cutting tools, sharp edges of moving materials)    
Stabbing or puncture hazard (sharp point of machinery or material)    
Friction or abrasion (fast-moving surface, eg abrasive wheel)    
Contact or entanglement (with machinery/material in motion)    
Impact hazard (impact from parts of machinery in motion)    
Crushing hazard (between moving machinery and static machinery/structure)    
Drawing-in hazards (eg rollers, conveyor belts, pulleys)    
Being struck by ejected parts of machinery    
Being struck by material ejected from machinery    
High pressure fluid ejection    

(2) Other hazards (Tick box for each applicable)
Hazard type   Notes
Falling or moving objects (eg insecure storage or poor material handling)    
Obstructions caused by poor storage or insufficient space    
Poor handling and lifting facilities    
Electricity (shock or burns)    
Chemicals or substances that may be toxic, irritant, flammable, corrosive or explosive    
Fire    
Explosion (due to pressure build-up)    
Noise (leading to loss of hearing, interference with communication)    
Vibration    
Radiation    
Hot or cold surfaces (burn, scald or sear hazards)    
Hot or cold work environment (causing health damaging effects)    
Mists, dust and fumes that can cause ill health or disease    
Poor lighting    
Poor ergonomic design (leading to long-term musculoskeletal problems)    
Instability (risk of toppling or overturning)    

(3) Risk control measures in place (Tick box for each applicable)
Control measure   Notes
Guards Fixed enclosing guard (held in place securely by suitable fastenings)    
Adjustable guard    
Distance or perimeter guard (not completely enclosing the danger zone but keeping persons at a distance from it)    
Interlocking guard (interconnected with the power/control system)    
Trip guard    
Protection appliances to distance parts of body/clothing from dangerous parts, eg jigs and mechanical holding devices    
Controls Adequate operating controls, positioned outside any danger zone, for starting, stopping and controlling the equipment    
Emergency stop controls at every control position    
Controls clearly marked to avoid confusion    
Controls constructed and positioned to prevent accidental operation    
Clear view from operating position that no one is at risk when starting equipment    
Overload protection devices    
Warnings Warning signals for starting equipment (visual/audible signals)    
Warning signals for operating equipment (visual/audible signals)    
Warning notices (instructions or prohibitions)    
Isolations Adequate means of isolation from electrical energy supply (isolating switch)    
Adequate means of isolation from hydraulic or pneumatic pressure (valve)    
Stability Suitable foundations or supporting structure    
Securing bolts or other fastenings    
Lashing or tying to a supporting structure    
Ballasting or counterbalancing    
Outriggers    
Mobile work equipment Rollover protective structures    
Falling object protective structures    
Restraining systems (seat belts or specific restraint systems)    
Means to prevent unauthorised starting    
Lighting Adequate general/local lighting for safe operation    
Additional lighting for maintenance/repairs    
Environment Ventilation    
Heating    
Weather protection    
Personal protective equipment Mandatory personal protective equipment for users of work equipment    
Instructions Rules, procedures or work instructions for a safe system of work    
Electrical Electrical inspection and testing regime in place    
Maintenance Maintenance programme in place    
Pressure vessel Pressure vessel inspection and testing regime in place    
Energy services Other energy supply inspection and testing regime in place    
Statutory inspections and test Statutory thorough inspection and testing regime in place    
Other measures      

(4) Risk assessment
For the intended use and the working environment: Do hazards associated with the work equipment present significant risks of injury or ill health to the user? Yes   No  
Do hazards associated with the work equipment present significant risks of injury or ill health to others (eg fellow workers, passers-by, pedestrians)? Yes   No  
Do engineering controls (guards and other protective devices) reduce risks, as far as practicable, to users and others? Yes   No  
Are risk control measures taken together (including personal protective equipment and other measures) suitable and sufficient to reduce risks to users and others to insignificant/acceptable levels? Yes   No  

(5) Actions
Action Person responsible Target completion date Completion date
       
       
       
       
       
       
       
       
       
       

Assessor details

Name:  
Title:  
Signature:  
Date:  

Approval

Name:  
Title:  
Signature:  
Date:  

Additional comments

 

 

 

When to use this document

Use this document to record work equipment assessments.

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