Sample forms

This guide has a number of forms and checklists to help you identify the important issues in the main subject areas. These forms are in the appropriate chapters of this guide, as indicated below.

a. Safety policy

See the appendix of managing occupational health and safety responsibilites Managing OH&S responsibilities.

b. Risk assessment, checklist and record forms

There is a range of risk assessment forms, covering a variety of hazards, available in:

General risk assessment — see page 5 of risk assessments.

Checklist for pregnant workers — see page 15 of risk assessments.

Display screen equipment (DSE) assessment — see page 17 of risk assessments.

Working at height risk assessment – see pages 6-7 of working at height.

Diagram showing the relationships between risk assessments and control measures — see page 22 of risk assessments .

Hazardous substances pre-assessment form — see page 21 of hazardous substances.

Hazardous substances summary assessment form — see page 23 of hazardous substances.

Ergonomic assessment form — see page 4 of occupational hygiene and ergonomics.

Noise assessment record sheet — see page 5 of noise.

Medical questionnaire and surveillance forms for exposure to vibration — see page 8 of vibration.

Accident and Incident reporting forms (Accident Book and RIDDOR examples) — see pages 8-12 of accidents.

Confined spaces risk assessment form — see page 5 of confined spaces Confined spaces.

Inspection forms for step-ladders and extending ladders — see pages 8 & 9 of working at height Working at height.

Diagram showing the spectrum of electromagnetic waves — see page 9 of electrical safety Electrical safety.

Contents checklist for first aid box — see page 5 of first aid First aid.

Checklist for additional first aid provisions — see page 6 of first aid First aid.

Fire risk assessment and audit checklist — see page 8 of fire safety Fire.

Checklist on the degree of worker involvement - see page 9 of health and safety management systems H&S management systems and page 6 of employee involvement Employee involvement.

Maintenance work risk assessment form — see page 12 of machinery safety Machinery safety.

Machinery Guarding inspection form — see page 13 of machinery safety Machinery safety.

Vehicle and pedestrian movements checklist — see page 7 of transport safety Transport safety.

Safety checklist and Ideas to Reduce Transport Risks — see page 8 of transport safety Transport safety.

Generic risk assessment for driving on company business — see page 14 of transport safety Transport safety.

Checklist for vehicle roadworthiness — see page 16 of transport safety Transport safety.

Example Mobile Phone policy — see page 17 of transport safety Transport safety.

Manual handling risk assessment form — see page 4 of manual handling Manual handling.

Examples of how to demonstrate competence — see page 3 of competence Competence.

Points to consider on managing contractors — see pages 4 & 5 of managing contractors Managing contractors.

Contractor assessment form — see page 6 of managing contractors Managing contractors.

Generic Permit-to-Work form for contractors — see page 7 of managing contractors Managing contractors.

Record sheet for monitoring contractor’s activities — see page 8 of managing contractors Managing contractors.

Work Organisation questionnaire — see page 4 of legislationA Managing stress at work.

c. Drugs and alcohol policy

An EEF specimen Alcohol and Drugs Policy can be found at http://www.eef.org.uk/UK/whatwedo/hrlegal/services/online/employmentguide/public/specimendocuments/default.htm

d. Accident investigation forms

An accident reporting form is shown at page 13 of accidents Accidents.

There are no prescribed forms for accident investigation as each case is different. Guidance on investigation procedures and techniques is given on page 5 Dealing with the aftermath of an accident of accidents Accidents.

e. Safety committee terms of reference

See page 5 of employee involvement Employee involvement.

f. Generic hierarchy of control

In circumstances where significant risks exist, there is often reference to a ‘hierarchy of control measures’. The terms used in any hierarchy listing will depend, to a great degree, on the type of risk and the likely severity should an accident occur.

All of these specific hierarchy listings are based on a simple approach as follows:

1. The first and most important aim is to eliminate the hazard on the basis of ‘if there’s no hazard, there can be no risk of injury’.

2. If elimination is not a possible or reasonable way forward, the next best approach is to isolate the hazard. Examples of this include:

a. machinery guards to prevent access to danger zones;

b. guard rails to prevent falls from elevated platforms;

c. containment of processes that use or generate hazardous substances together with extraction facilities to remove vapours etc. before the containment area is opened for access;

d. covering live electrical conductors with insulating material to prevent contact and the risk of death; and

e. many other similar situations.

3. If isolation is not possible or practicable, then contact with or exposure to the hazard needs to be minimised in some other way.

4. This method should be considered as a last resort because the risk of injury becomes dependent on too many variables. Examples of minimisation include the use of:

a. personal protective equipment (PPE);

b. permit-to-work systems;

c. safe operating procedures; and

d. other similar ‘human driven’ systems.

The inherent problems with these methods of minimisation are that they depend on operators and supervisors/managers following particular procedures. There may be a risk of death or serious injury if the procedures are not followed. This could occur if anyone involved in the activity concerned becomes distracted, even for a short period.

In summary, the three basic elements of a hierarchy of control are (in priority order):

  • eliminate;
  • isolate; and
  • minimise.
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