FORM:

Health, Safety, and Environment (HSE)

TITLE:

PLANT/EQUIPMENT &/OR TASK RISK ASSESSMENT

NUMBER:

F01.1_2

P 00012

Risk Assessment Reference #

Work Area

Switchboards & Contracting

Location of Plant/Equipment

Regency Park

Plant/Equipment #

Komatsu Forklift GF25-12

Date of Assessment

8 February 2012

Assessed by

Debbie Nation/Dario
Dametto/Nathan Bissell

Last reviewed (if applicable)

Task and/or use of Plant/Equipment
Moving and lifting loads, loading and unloading
Reason for Assessment

Comment

Review Existing Task

New Task
Change in task, or
legislation
Report of injury

Requested

Is the task or use of the plant/ equipment a hazardous manual handling task If any of the boxes have
been ticked/checked a separate Manual handling risk assessment requires be completed and
attached/referenced to this risk assessment.
Repetitive
or
sustained
force

Task

High or
sudden
force

Sustained
or
awkward
postures

Repetitive
movement

Exposure
to
vibrations

Operating Forklift (Reversing)

Lifting items
Moving items
Loading & Unloading
Ascending & Descending forklift cabin
Changing forklift gas cylinder

Hazard

Consequence

Uncontrolled when printed

Version: 2
Issued: August 2011
Review: 2016

No
No

Rx Number
Reason for no

Controls

MH 008
Risk Post
RatingControl

Re
f#

Yes
Yes

Rating
Risk

Manual Handling Risk Assessment Required

Attached ( if no give reason)

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 Ensure forklift is fitted with speed control

devices ( Max 10km/hr)
Ensure personnel wear high visibility clothing
when in areas where forklift operates
Ensure tines set at maximum width for load
Keep tines at the correct height low to the
ground with backtilt when travelling with load
Ensure personnel wear high visibility clothing
when in areas where forklift operates
Ensure warning light is on top of the forklift to
improve conspicuity.
Develop Floor Traffic Management Plan
Ensure forklifts are fitted with seatbelts
Ensure forklift is fitted with speed control
devices.
Ensure operator is trained and competent in
the use of the forklift and is aware of its
lifting capacity.
Provide weather/rain protection where
required, as practicable.
Ensure good housekeeping by cleaning up oils
spills
Ensure tyres are well maintained
Ensure inspection and maintenance is
conducted in refuelling area
Ensure no hot work or naked flames in or
around refuelling area (within 6 metres)
Prevent any sparks or naked flames from
entering the refuelling area.
Ensure pre-start checks are completed daily
Ensure maintenance schedules are maintained
Maintain three points of contact getting on and
off the forklift
Negotiate one step at a time and do not jump
down from the forklift cabin
Ensure steps are clean and free from oil or
slippery substances before ascending or
descending

Load falls off

elevated tines onto
pedestrian whilst
travelling

Crush injury

M8

Forklift hits
pedestrian

Crush injury

M8

Forklift tips over

Crush injury

M8

Forklift loses
control on wet
surface

Crush injury

M8

During refuelling
gas leak occurs

Explosion

H12

Hydraulic hose
burst spraying oil

Environmental/eye
injury

M6

Fall getting on/ off

forklift

Sprain, strain,
laceration

M6

Musculo-skeletal
injury

M6 Alternate looking over left and right shoulders

L4

H12 Ensure tips of tines are painted yellow to

improve conspicuity
Instruct workers to keep tines at the correct
height low to ground with backtilt when
travelling without load.
Ensure personnel wear high visibility clothing
when in areas where forklift operates

M4

8
9

Twisting back to
look when
reversing
Tines puncture
object or person

Puncture injury,
Property damage

Uncontrolled when printed

Version: 2
Issued: August 2011
Review: 2016

L4

L4

L4

L4

M4

L3

L3

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10

Changing forklift
gas cylinder

Develop Floor Traffic Management Plan

Ensure fork gas cylinder has been
disconnected and straps removed before
attempting to lift from forklift
Wear gloves and get firm grip with both hands
M6
when handling cylinder.
Keep body aligned when lifting (nose over
toes)
Know your own limitations and seek
assistance if required.

Musculo-skeletal
injury

Action Plan Developed

Yes

No

Ref Number

Attached ( if no give reason)

Yes

No

Reason for no

Uncontrolled when printed

Version: 2
Issued: August 2011
Review: 2016

L4

AP 00016

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Examples Risk Assessment: Measures of Consequence (or Impact)

Level

HSE

1. Insignificant
2. Minor
3. Moderate

4. Major

5. Catastrophic

Environment

No significant injuries.
No significant impact on personnel.
Small number of injuries; first aid or out-patients treatment
required.
Some inconvenience to personnel.
A number of injuries requiring hospitalisation and long-term
treatment.
Moderate disruption to work routines and schedules.
Major disruption to work routines and practices. Additional
resources may be required.
Significant number of serious injuries requiring hospitalisation
and long-term treatment. Small number of fatalities.
Long-term disruption to work practices and routines. Impact on
well-being of personnel. Extensive, life-threatening impact;
potentially large numbers of serious injuries and fatalities.

Minor breach of environmental policy / practices.

Negligible impact on the environment.
Minor localised impact; one-off situation easily
remedied.
Moderate impact on the environment; no long term or
irreversible damage. May incur cautionary notice or
infringement notice
Severe impact requiring remedial action and review of
processes to prevent reoccurrence. Penalties and / or
direction or compliance order incurred.
Long-term, large-scale damage to habitat or
environmental.
Serious / repeated breach of legislation / licence
conditions.
Cancellation of licence and / or prosecution.

Risk Assessment: Measures of Likelihood

Level
Almost certain

Description (As per AS/NZS 4360)

Examples

The event is expected to occur in most conditions

Expected frequency range: Greater than one or more per annum

Expected frequency range: Between one in 5 years and one per
annum
Expected frequency range: Between one in 10 years and one in 5
years
Expected frequency range: Between one in a 100 years and one in
10 years

Likely

The event will probably occur in most conditions

Possible

The event should happen at some time

Unlikely

The event could happen at some time

Rare

The event may only occur in exceptional

circumstances

Expected frequency range: Less than one in a hundred years

Consequence/Severity
Likelihood
Rating

Catastrophic

Major

Moderate

Minor

Insignificant

Almost certain

Extreme (25)

Extreme (20)

High (15)

High (10)

Medium (5)

Likely

Extreme (20)

Extreme (16)

High (12)

Medium (8)

Medium (4)

Possible

High (15)

High (12)

High (9)

Medium (6)

Low (3)

Unlikely

High (10)

Medium (8)

Medium (6)

Low (4)

Low (2)

Rare

Medium (5)

Medium (4)

Low (3)

Low (2)

Low (1)

Risk Rating

Timeframe

Whom

Extreme

immediate action required executive management and

HSE

High

Within 2 to 3 days senior management attention needed

HSE Manager, Division Manager, Construction Manager ,

HSR & Safety-Coordinator
Construction Manager, Project Manager, Safety
coordinator, HSR & Supervisor

Moderate

Within a week management responsibility must be specified

Project Manager, Safety Coordinator , HSR & Supervisor

Low

Within 14 days manage by routine process.

Supervisor

Uncontrolled when printed

Version: 2
Issued: August 2011
Review: 2016

Page 4 of

Uncontrolled when printed

Version: 2
Issued: August 2011
Review: 2016

Page 5 of