Work at Height Risk Assessment Identification of Work at Height Activities Task : Are all the work at height activities identified? YesNo Are all the access and egress routes that involve work at height identified? YesNo Are the Employees/Contractors/Members of public at risk from work at height identified? YesNo Identify the Hazards (tick which is relevant) Access to an area at heightFragile roofObjects falling from heightUse of portable ladders, extendable laddersEgress from an area at heightUnprotected edgesUse of step ladders/podiumsUse of Mobile Elevating Working Platforms (MEWPs)Use of fixed ladders Use of incorrect access equipment Hazard Consequences The incorrect choice of access equipment can lead to a fall from a height resulting in: - Fatality - Serious Injuries - Damage to equipment/materials Control measures - Assessment of requirements for work at height resulting in access equipment choices. - Work at height training. Use of defective access equipment Consequences Equipment may be: - Poorly maintained - Damaged Use of defective equipment can lead to collapse leading to a fall from a height resulting in: - Fatality - Serious injuries -Damage to equipment/materials Inappropriate use of access equipment Consequences Access equipment may not be: - Secured correctly. - Erected correctly. The use of inappropriate equipment can lead to collapse leading to a fall from a height resulting in. - Fatality - Serious Injuries - Damage to equipment/materials Overloading of access equipment Consequences Using access equipment as a work platform and storing materials on it can result in overloading leading to failure and collapse leading to a fall from height resulting on - Fatality - Serious injuries - Damage to equipment/materials Inappropriate environment for use of access equipment Consequences Equipment may be used: - On uneven floors. - On unmade ground. - Without stabilisers (eg: outriggers, locks, ect,). Assessment Form You can add more hazards by checking the 'Add Another Hazard' box at the bottom of the form Hazard ref: 1 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 2 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 3 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 4 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 5 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 6 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 7 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 8 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 9 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 10 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 11 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): + Add: Add another Hazard Hazard ref: 12 Hazard: Persons at risk: Control measures: Initial Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Further Action Required?: Residual Risk: Likelihood: —Please choose an option—l-1l-2l-3l-4l-5 Severity: —Please choose an option—s-1s-2s-3s-4s-5 Risk Level: —Please choose an option—r1r-2r-3r-4r-5r-6r-7r-8r-9r-10r-11r-12r-13r-14r-15r-16r-17r-18r-19r-20r-21r-22r-23r-24r-25 Due (date): You cannot add any more items, please fill in another form Name: Date: Signature