Road Vehicle Risk Assessment Form
ਫ਼ਾਰਮ - Version 2
Road Vehicle Risk Assessment Form · FORM-31202
- Risk Assessment No.
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- Risk Assessment Approved by:
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- Company Name:
- [Company]
- Address:
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- Name/Signature:
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- Contact Name:
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- Position:
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- Phone No.:
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- Job Title:
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- Date:
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- Location:
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- No. of workers at the workplace:
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- Assessor Name/Signature:
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- Assessor Job Title:
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- Specify:
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- Specify:
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- Specify:
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- Specify:
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- Names of workers consulted with during the development of this Risk Assessment/Signature/s:
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- Job Title/s:
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- Date:
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- Person Responsible for ensuring compliance with Risk Assessment/Signature:
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- Job Title:
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- Date:
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| Consequence → | |||||
|---|---|---|---|---|---|
| Likelihood ↑ | InsignificantNo effect, or so minor that the effect is acceptable | MinorMinor first aid treatment, minimal business disruption, minimal environmental effect | ModerateSerious injuries, medium business interruption, medium environmental impact | MajorExtensive injuries or fatality, significant business interruption, environmental harm, prosecution | CatastrophicMultiple permanent disabilities or fatalities, business failure, substantial environmental harm, prosecution or imprisonment |
| Almost certainExpected in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| LikelyWill probably occur in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| PossibleCould possibly occur at some time | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| UnlikelyUnlikely but possible | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| RareHighly unlikely to occur | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High |
- 1 L1 LowRecord and monitor. Proceed with work, and review the risks regularly.
- 2 M2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
- 3 H3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
- 4 A4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.
- Scope of Risk Assessment
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- Description of Job/Task
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Hazards and control measures
Road hazard – speed/mechanical: Can the workers' risk levels be increased or affected?
Road hazard - environmental conditions: Can the workers' fatigue levels be increased or affected by the environmental conditions at the workplace?
Road hazard: Can the workers' risk levels be increased or affected by road hazards?
Worker factors: Can the workers' risk levels be increased or affected by worker factors?
Loading and unloading: Can the drivers potential to speed be increased or affected by loading and unloading schedules?
Information and instruction: Can the drivers potential to speed be decreased by improved training, information and communication?
Mass management: Can an overloaded vehicle impact road performance, mechanical safety and/or damage infrastructure?
Dimension management: Could an over-dimension load affect road safety, mechanical integrity and/or cause harm to people or infrastructure?
Load restraint: Could a poorly restrained load affect road safety, mechanical integrity and/or cause harm to people or infrastructure?
Vehicle maintenance: Could vehicle maintenance practices affect road safety, mechanical integrity and/or cause harm to people or infrastructure?
Driver actions: Could driver actions cause an accident or harm to themselves or others?
Slips, trips and falls – Is there potential for a slip, trip or fall to occur?
Falling objects - Is there potential for falling objects to cause damage or harm to people?
Traffic management - Can site traffic management impact health and safety and/or damage infrastructure?
Other hazard – other:
Monitor and review
- Person/s Responsible:
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- Signature/s and Date:
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Name: | Initial: | Date: | |
|---|---|---|---|
Worker Sign-Off & Acknowledgement
This Risk Assessment has been developed in consultation and cooperation with workers and relevant Organisation. I have read the above Risk Assessment, and I understand its contents. I confirm that I have the skills and training, including relevant certification, to conduct the task as described. I agree to comply with safety requirements within this Risk Assessment, including risk control measures, safe work instructions, and Personal Protective Equipment described.
| Worker’s name | Job role / positione.g. supervisor, worker, trainee | Company | Date | Signature |
|---|---|---|---|---|
| - | - | - | - | - |
| - | - | - | - | - |
| - | - | - | - | - |
ਇਸਦੀ ਸੇਧ ਅਤੇ ਮਿਸਾਲੀ ਐਂਟਰੀਆਂ ਲੌਕ ਹਨ
ਤੁਸੀਂ ਵੇਖ ਸਕਦੇ ਹੋ ਕਿ ਫ਼ਾਰਮ ਕਿਵੇਂ ਬਣਿਆ ਹੈ। ਇਸਨੂੰ ਲਓ ਅਤੇ ਕਿਸੇ ਵੀ ਡਿਵਾਈਸ 'ਤੇ ਭਰੋ, ਪ੍ਰਿੰਟ ਕਰੋ, ਜਾਂ ਆਪਣਾ ਬਣਾਓ।
Road Vehicle Risk Assessment Form · FORM-31202
