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RISK ASSESSMENT RECORD


RISK ASSESSMENT NO :
PROJECT NAME : DATE :
CONTRACTOR : LOCATION :
BRIEF DESCRIPTION OF WORK/ACTIVITY:
RISK ASSESSMENT TEAM: Accepted: Yes/ No
Name: Signature
Title/Appointment Signature
Initials & Surname
Construction Manager:

Contractors Site Manager

Contractor Supervisor

Contractor Safety Officer Comments:

Competent Person

ACCEPTED

Asanko Supervisor

Asanko SHER Officer

Asanko Project SHE Manager

Client Representative

EXISTING CONTROL MEASURES: (SUBMIT & ATTACH TO RISK ASSESSMENT)


Available Adequate Changes Required Remarks
Yes No Yes No Yes No

Procedures: (SOP) (SWP)


Training:
Code of Practice:
Standardized Risk Matrix Hazard Effect/ Consequences
(Where an event has more than one “Loss Type”, choose the “Consequences
Monitoring with the highest rating)
Loss Type 1 2 3 4
Controls Effective MajorResponsible Person
5
(Additional “Loss Types” may exist for an event; Insignificant Risk/ Hazard Minor Moderate Name/Sign
Catastrophic
List Activities of Task List Hazards/ Risks List Controls & Methods Yes/No/Date
Identify & rate accordingly) Rating
(S/H) First-Aid case / Exposure to Medical Treatment case / Lost time injury / Reversible
Yes Single
No fatalityDateor loss of Multiple
Name fatalities / Impact
Sign
Harm to People (Safety/Health) minor health risk Exposure to major health impact on health quality of life / Irreversible on health ultimately fatal
1) Selection of Personnel Incompetent workforce which can risk competent operators, impact on health


Select
lead to incidents 25 drivers, riggers and general Supervisor
(EI) Minimal environmental
Material environmental
hands Serious environmental harm Major environmental harm Extreme environmental
Environmental Impact harm – L1 incident
harm – L2 incident – L2 incident remediable – L2 incident remediable harm – L3 incident
2) Inspection of equipment Equipment failure remediableEnsure equipment
short term andLOM
within slings are post LOM irreversible
and slings (BI/MD) No disruption to operation / under good
Brief disruption on conditions
Partial shutdown / R60m to Partial Loss of operation / Substantial or total loss of
Ensure load
lessis within safe weight

Business Interruption / Material Damage & Other R600k to less than R6m operation / R6m to less than R600m R600m to less than R6bn operation / R6bn and more
Consequential Losses 21 limit
than of the machine
R60m operator

(L/R) Low level legal issues


Minor legal
Goodissues; non-keeping
House Serious
and breach
wear of law; Major breach of the law; Very considerable penalties
Legal & Regulatory Slip, trip and fall compliancesuitable
and breaches
PPE of investigation/report to considerable prosecution & prosecutions. Multiple law
law authority; prosecution and penalties suits & jail terms.
3) Inspection of work area Unstable that can lead to toppling Unsure ground condition is
and/or moderate penalty
of equipment suitable. possible
(R/S/C) Slight impact – public Limited impact – local Considerable impact – National impact – national International impact –
Impact on Reputation / Social / Overhead
Community cablesawareness may exist but no 21
public concern
public concern
Direct supervision regional public concern
 public concern international public
supervisor
attention
Likelihood Examples {Consider Risk Rating
near-hits as well as actualEffect on other activities/ workers
events} Barricade work area
in the area
4)5 Securing
The and
unwanted event has occurred
loosening Fall of load 11 (M)
18 16 (H) 20 (H)
Ensure load is properly rigged or
23 (Ex) 25 (Ex)
Almost frequently; occurs in order of one or more
of load secured by competent rigger
Certain times per year & is likely to reoccur within


1 year Manual Handling 7
4 The unwanted event has occurred 7 (M) Use
12 Suitable PPE etc. Hand
(M) 17 (H) 21 (Ex) Rigger 24 (Ex)
Likely infrequently; occurs in order of less than gloves
once per year & is likely to reoccur within 5
years Slip Trip and Fall 8 Direct supervision
3 The unwanted event has happened in the 4 (L) 8 (M) 13 (H) 18 (H) 22 (Ex)
Struck by load 18 Selection of competent operator
5) Loading
Possible business at some time; or could happen
and off-loading
within 10 years

Inclement weather
Use of tagline to control load
Stop Work
 Operator/
Supervisor
2 The unwanted event has happened in the 2 (L) 5 (L) 9 (M) 14 (H) 19 (H)
Unlikely business at some time; or could happen
within 20 years

1 The unwanted event has never been 1 (L) 3 (L) 6 (M) 10 (M) 15 (H)
Rare known to occur in the business; or it is
highly unlikely that it will occur within 20
years

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