Scribd
Upload
165 views3 pages

Location Risk Assessment Form-Part A: Basic Information & Hazard List

This document is a location risk assessment form with 3 parts: Part A collects basic information about the production such as location, dates, and identifies potential hazards from a provided list. Part B assesses the risks of identified hazards, who may be exposed, control measures, and residual risk level. Part C provides emergency contact details including services, phone numbers, and addresses for assistance in an emergency situation.

Uploaded by

api-330049796
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
165 views3 pages

Location Risk Assessment Form-Part A: Basic Information & Hazard List

This document is a location risk assessment form with 3 parts: Part A collects basic information about the production such as location, dates, and identifies potential hazards from a provided list. Part B assesses the risks of identified hazards, who may be exposed, control measures, and residual risk level. Part C provides emergency contact details including services, phone numbers, and addresses for assistance in an emergency situation.

Uploaded by

api-330049796
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

Location Risk Assessment Form- Part A: Basic Information & Hazard list

Production Name: Organisation

Production Address: Producer


Email:
Mobile:

Start date End date

Distribution

Outline of risk assessment

Team members / experts / contractors


/ contributors etc.

Locations

Assessor Name Date completed


Signature

Authoriser Name Date authorised


(if not Assessor) Signature

Hazard list select your hazards from the list below and use these to complete Part B
Situational hazards Tick Physical / chemical hazards Tick Health hazards Tick
Assault by person Contact with cold liquid / vapour Disease causative agent
Attack by animal Contact with cold surface Infection
Breathing compressed gas Contact with hot liquid / vapour Allergic reaction
Cold environment Contact with hot surface Lack of food / water
Crush by load Electric shock Lack of oxygen
Drowning Explosive blast Physical fatigue
Entanglement in moving machinery Explosive release of stored pressure Repetitive action
High atmospheric pressure Fire Static body posture
Hot environment Hazardous substance Stress / anxiety
Manual handling Ionizing radiation Venom poisoning
Object falling, moving or flying Laser light

Obstruction / exposed feature Lightning strike Environmental hazards


Sharp object / material Noise Litter
Shot by firearm Non-ionizing radiation Nuisance noise / vibration
Slippery surface Stroboscopic light Physical damage
Trap in moving machinery Vibration Waste substance released into air
Trip hazard Waste substance released into soil / water

Vehicle impact / collision Managerial / organisational hazards


Falls from height Management factors (lack of communication, co-
operation, co-ordination and competence)

Risk matrix use this to determine risk for each


hazard i.e. how bad and how likely Likelihood of Harm
Remote Very unlikely Unlikely Possible Likely
Severity of Harm e.g. <1 in 1000 chance e.g. 1 in 200 chance e.g. 1 in 50 chance e.g. 1 in 10 chance e.g. >1 in 3 chance

Negligible e.g. small bruise Trivial Trivial Trivial Low Low

Slight e.g. small cut, deep bruise Trivial Trivial Low Low Medium

Moderate e.g. deep cut, torn muscle Trivial Low Medium Medium High

Severe e.g. fracture, loss of consciousness Low Medium High High Extremely high

Very Severe e.g. death, permanent disability Low Medium High Extremely high Extremely high
Risk Assessment Form Part B: Hazards & Control Measures
Hazards Who exposed Risk Control measures Risk
Risk Assessment Form Part C: Emergency Contact information
Job Title Name Phone No. Email Emergency Contact/Relationship

Address
Emergency Service CUMBRIA (101) ask for Carlisle City Carlisle City Centre, Civic Centre, Rickergate Carlisle CARLISLE COLLEGE MAIN RECEPTION CAN BE
CONSTABULARY Centre NPT CA3 8QG
REACHED ON
Emergency Service CUMBERLAND 01228 523444 Newtown Rd, Carlisle
INFIRMARY CA2 7HY 01228 822700
Emergency Service FIRE 01228 221689 Eastern Way, Carlisle
SERVICE CA1 3RA IN AN EMERGANCY ALWAYS CALL 999

You might also like