GENERAL RA FORM

Name(Required)

First Last

Date(Required)

Site/Location(Required)

Is there a risk?

Risk Evaluation = Having identified the hazards, the level of the risk will be assessed based on qualitative measures. The severity of the risk will either be termed as High, Moderate or Low. High: Extremely harmful e.g. (amputations, permanent loss of sight, major fractures, poisoning and gassing, fatal injuries, severe life-threatening disease, acute fatal diseases etc & major damage to property, equipment or to the environment.) Moderate: Harmful e.g. (laceration, serious cuts and bruises, burns, serious sprains, minor fractures, occupational deafness, dermatitis, allergy, repetitive strain injury ill health leading to permanent disability etc, and serious damage to equipment, property, or the environment). Low: Slightly harmful e.g. (superficial injuries, minor cuts and bruises, eye irritation, ill health leading to temporary minor disability etc, minor damage to equipment, property, or the environment

Access/Egress: Building(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Access/Egress: Area(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Chemical Hazard(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Confined Space(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Dust(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Electrical Installations(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Fire(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Housekeeping(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Manual Materials Handling(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Noise(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Pressure(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Temperature(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Tools and Equipment(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

Visual Display Equipment(Required)

YES

N/A

Evaluate the risk(Required)

HIGH

MODERATE

LOW

Note the controls in place to reduce/remove the risk(Required)

PPE (Personal Protective Equipment)

Laced Safety Boots ( S3 Rating)(Required)

YES

N/A

Helmet with chinstrap(Required)

YES

N/A

Safety gloves to EN388(Required)

YES

N/A

Hearing protection above 80db(Required)

YES

N/A

Safety glasses with lanyard(Required)

YES

N/A

Respiratory protection(Required)

YES

N/A

High Visibility Vest with company name(Required)

YES

N/A

Other Comments

General Safety Audit and Risk Assessment

Is there a risk?

PPE (Personal Protective Equipment)

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