Company Logo Make risk assessement site specific below is a guide only

GENERIC SAFETY, HEALTH & ENVIRONMENT RISK ASSESSMENT FORM

Activity Description: Nonspecific risk assessment (add new title here)

ID Hazard Adverse Effects Persons Affected Controls A S L R T

Works vehicle Accessing Vehicle Collision causing
Working Area death or injury
1 Y
Driving in works area Vehicle striking operatives
causing death or injury
2 access.
Working Area, vehicles Operative being struck by
3 entering or operatives vehicle
moving out into traffic
Delivery to works area Vehicle striking operative or
another vehicle causing
death or injury
4 drivers to remain in designated holding
All people working within
the site.
All people working within
the site.
All people working within
the site and the passing
public
All people working within
the site.
At 200 metres point prior to works access
switch on beacons.
Turn on indicator at 100 metres point,
slow down and make sure that works
4 2 Hi Y
access is free and clear.
Pull in at access point and move away
from entrance. Do not park near to works
access
Ensure site speed limit adhered to
Park all vehicles away from works
Y 4 1 Me Y
Keep beacons on until arrival in position
you intend to park.
Safety zone of 1.5m for all road speeds
Y 4 1 Me Y
Ensure that all delivery drivers are aware
how to access and egress a work site
and the location of access points.
The site induction must instruct delivery
Y 4 2 Hi Y
area prior to off loading. This to be pre
arranged prior to work starting and must
be under sole control of the designated
competent banks man

Key: A = ALARP (As Low As Reasonably Practicable)? (Y or N) S = Severity (1 5) L = Likelihood (1 5) R = Risk Classification (In / Lo
/ Me / Hi / Cr) T = Tolerable? (Y or N)
Rev: Date: Ref: Page 1 of 3
UNCONTROLLED IF COPIED OR PRINTED
 Company Logo Make risk assessement site specific below is a guide only

Work Adjacent to a Cuts, Bruises, Fractures, Ensure that any reversing is undertaken
All people working within
Moving /Reversing Impact and Death. either using camera or under strict Y 4 1 Me Y
the site
Vehicle supervision of a banksman
Parking in closure and Death, damage to vehicle, Park away from access/egress point.
another vehicle in closure cuts, bruises etc. All people working within
Park away from safety zone, as far into
strikes it the site and the passing Y 4 2 Hi Y
the side as possible to allow other
public
vehicles to pass safely.
Hiab or crane operating Death, serious injury vehicle The siting of the vehicle should be such
in closure overhanging strike cuts, bruises etc. Allpeople working within that the crane, arm, ballast or other such
into safety zone or live the site and the passing peripheral of vehicle cannot under any Y 4 1 Me Y
traffic public circumstances overhang the safety zone
or delineation cones next to live traffic
Distraction of members of Death, serious injury or All people working within Any works that could distract i.e. welding,
public driving adjacent to vehicle strike the site and the passing cutting safety fence must be carried out Y 4 2 Hi Y
works. public behind a barrier to prevent distraction.
Member of public driving Vehicle striking operative Taper positions must be planned to allow
into works good visibility for oncoming drivers.
All people working within
the site and the passing Use VMS and matrix signing if available Y 4 2 Hi Y
to improve awareness of TM
public
Ensure all persons in the closure are
wearing appropriate PPE
Traffic Background Noise Deafness As a general rule, if the noise in the
All people working within works area is such that you cannot hold
1 a conversation with someone two metres Y 4 1 Me Y
the site.
away without shouting then hearing
protection must be worn.

Key: A = ALARP (As Low As Reasonably Practicable)? (Y or N) S = Severity (1 5) L = Likelihood (1 5) R = Risk Classification (In / Lo
/ Me / Hi / Cr) T = Tolerable? (Y or N)
Rev: Date: Ref: Page 2 of 3
UNCONTROLLED IF COPIED OR PRINTED
 Company Logo Make risk assessement site specific below is a guide only

Egressing from the works Vehicle Collision causing Vehicle beacons must be switched on
area, death or injury whilst your vehicle is moving
Stick to site speed limits
All people working within Egress where the clearly marked exit
11 the site and the passing board and accelerate as necessary Y 4 2 Hi Y
public Join the moving traffic when safe to do
so.
Turn your beacon off when you have
safely joined the moving traffic.
Assessor Na e: Si nat re: Date:

Key: A = ALARP (As Low As Reasonably Practicable)? (Y or N) S = Severity (1 5) L = Likelihood (1 5) R = Risk Classification (In / Lo
/ Me / Hi / Cr) T = Tolerable? (Y or N)
Rev: Date: Ref: Page 3 of 3
UNCONTROLLED IF COPIED OR PRINTED