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SCHOOL-OF-SCIENCES

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					        SCHOOL OF HEALTH, NATURAL AND SOCIAL SCIENCES

                                    RISK ASSESSMENT FORM

1)
Building/Lab./Room:
Assessor(s):
Reference Number (Location/Number):
Date of Assessment:
Assessment Review Date (5 years Max):
Note: re-assessment is required if there is reason to suspect that the original assessment is no longer
valid. (accident occurs, change of activity/personnel..)

2)
Title of Activity: ………………………………………………………………………………….
Brief description of Activity (or attach schedule)




3)
LIST OF HAZARDS:
WHAT HAZARDS ARE PRESENT, WHICH COULD RESULT IN SIGNIFICANT HARM
                    HAZARD                                               CHECKLIST
                                                  Slips, trips and falls        Movement of people

                                                        Use of tools and equipment    Obstructed access
                                                        Electrical hazards            /egress
                                                                                      Overcrowding
                                                        Sources of heat or ignition   Lone working
                                                        Use of hazardous              Lack of instruction/
                                                        substances*                   training

                                                        Noise *                       Lack of supervision
                                                        Dust and fumes                Stress
                                                        Micro-organisms               Use of sharps/glassware
                                                        Mechanical hazards
                                                        (entanglement, entrapment)*
                                                        Manual handling operations*   Display Screen
                                                                                      Equipment*
Note: Those hazards marked * require more specific assessment documentation. See Area H&S
Adviser for details.

4) WHO MIGHT BE HARMED AND HOW ?
                      WHO                                           HOW MIGHT THEY BE HARMED ?
 STAFF (ACADEMIC, TECHNICAL, CLERICAL,
 MANUAL, PROFESSIONAL)
 OTHER STAFF - please state:

 STUDENTS (UNDERGARADUATE, POSTGRADUATE)
 OTHERS (CONTRACTORS, VISITORS, MEMBERS OF
 THE PUBLIC)
 Please state:


H&S/ Riskass.doc / Revision 4/ Nov.. 2006                                              Page 1 of 3
5) CONTROL MEASURES ALREADY IN PLACE:
               CONTROLS                                                 CHECKLIST
                                                Information, instruction and training
                                                Staff / student training
                                                Safe system of work (specify)
                                                Personal protective equipment (specify)
                                                Safety technology ( RCD, guarding, sensors, …)
                                                Local exhaust ventilation, fume cupboards
                                                Planned preventative maintenance
                                                Inspection and testing regimes
                                                Routine monitoring / supervision




6) ADDITIONAL CONTROLS REQUIRED:
                   CONTROLS                             BY WHO                      BY WHEN




7) EMERGENCY PROCEDURES WHERE SPECIAL HAZARDS EXIST (INCLUDING FIRST AID):




8) METHOD OF DISPOSAL
   (For substances consult Material Safety Data Sheet (MSDS))




9) COMMENTS/ACTIONS/RECOMMENDATIONS




Risk Rating

Signature of Assessor                                                      Date

Signature of Additional Competent Person:                                  Date
(E.g. Supervisor/Line manager/H&S adviser)




H&S/ Riskass.doc / Revision 4/ Nov.. 2006                                      Page 2 of 3
Check your Assessment using the information below:

ASSESSMENT OF RISK
          CONSEQUENCES OF HARM ( VERT)                             LIKELIHOOD OF HARM OCCURRING (HORIZ)
 1 Minor injury                                                 1 Highly unlikely, not known to occur

 2 Over 3 day injury / occupational illness                     2 Remote possibility, but known to have occurred

 3 Serious injury / Temporary incapacity / occupational         3 Can occur, can be reasonably foreseen
   disease
 4 Loss of limb or eye/ Permanent disability / fire             4 Likely to occur, previous history of such events

 5 Fatality / explosion / toxic release                         5 Highly likely, quite foreseeable, well known risk

Use the grid below to determine the overall assessment of risk

          5                                                 Insignificant        No action needed.
                                                V
                                            VV          V
                                                            Low risk Continue to monitor the work activity.
         4
                                      H
                                                            Medium risk          Identify additional cost effective measures to reduce
         3                                                                       risk, implement and monitor.
                              M
                                                            High risk            Unacceptable: Identify additional controls – implement
         2                                                                       and review assessment asap.
                          L
                                                            Very high risk       Intolerable: Stop activity – identify additional controls
         1      Iii                                                              –implement – review assessment and monitor new
                  I                                                              arrangements carefully.
         0
                      1   2       3         4       5




H&S/ Riskass.doc / Revision 4/ Nov.. 2006                                                                Page 3 of 3

				
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