Plant and Equipment Risk Management Form

1. Hazard Management Details – General

Plant/Equipment Item: Forklift (Electric) Make/Model No.: Serial No.:

School / Work Location: Region:

Name of Person(s) Conducting Activity: Date Conducted:

Description of Use: Summary of Key Risks:

(refer to appropriate subsections)
A forklift is a motorised vehicle which  Entanglement
uses power-operated prongs/tines to  Impact and cutting injuries
lift and move heavy loads.
 Shearing
 Electricity
 Ergonomics
 Slips, Trips or Falls

Last Updated: 21 August 2018

 Plant and Equipment Risk Management Form

2. Documentation
Relevant Legislation/Standards Y/N Comments
Is plant required to be registered? Y N
Is a user license required? Y N
Key Reference material AS 2359 Powered Industrial Trucks – General Requirements, WorkSafe Victoria Guidance
Note: “Forklift Safety, Reducing the Risk.”
Plant Documentation Y/N Comments
Are operator’s manuals accessible? Y N Operators manual should be supplied on purchase of the vehicle
Is this a restricted use item? Y N Operators must have an appropriate fork lift licence
Does this item require safe use Y N Operators must have an appropriate fork lift licence
documents/test?

3. Hazard Identification

Hazards Inspected Risk Assessment Description of Risk Control Measures

Cons Like Risk
Level
ENTANGLEMENT Major Rare Medium Loose clothing, long hair, Ensure clothing, gloves, hair or
Can anyone’s hair, clothing, gloves, cleaning gloves, body parts and other such items are kept clear
brushes, tools, rags or other materials other material may of moving parts of the forklift
become entangled with moving parts of the become entangled in when operating or performing
plant or materials? moving parts of the maintenance (e.g., overalls can
Y N forklift (e.g. chain mast). be used to restrict loose
clothing etc.).

Remove or secure any

packaging that may become
entangled in the chain mast.

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 Plant and Equipment Risk Management Form
Hazards Inspected Risk Assessment Description of Risk Control Measures
Cons Like Risk
Level
IMPACT AND CUTTING INJURIES Materials could fall from Ensure only licensed persons
Can anyone be crushed/cut/struck etc. due the tines of the forklift or operate the forklift and have
to: pallet whilst in operation been trained in any Safe Work
 Material falling off the plant? Y N Major Possible High if not appropriately Procedures (SWP).
secured.
 Uncontrolled/unexpected movement of Major Rare Medium
Y N Ensure the forklift is only
plant/load? Forklift could rollover if operated on appropriate
 Lack of capacity to slow, stop or Severe Rare Medium the load is unbalanced, surfaces (i.e. level ground) and
Y N
immobilise plant? operated on an uneven a seatbelt is worn at all times.
 The plant tipping or rolling over? Y N Severe Rare Medium surface or traversing a
 Parts of the plant disintegrating or Severe Rare Medium slope. Ensure the load is within the
Y N forklifts lifting capacity and is
collapsing?
 Contact with moving parts during testing, Major Rare Medium The mobility of the forklift appropriately secured before
inspection, operation, maintenance, Y N poses a significant risk to lifting and moving.
cleaning or repair? pedestrians and property.
 Being thrown off or under the plant? Severe Rare Medium Ensure the forklift is serviced or
Y N
Use of inappropriate repaired by a qualified person
 Contact with sharp or flying objects? parts could lead to and only manufacturer
Y N
(e.g. work pieces being ejected) mechanical failure. recommended parts and
 The mobility of the plant? Y N Severe Rare Medium accessories are used.
Operator error (e.g. poor
 Inappropriate parts and accessories Severe Rare Medium visibility, fatigue etc.) Ensure appropriate traffic
Y N
being used?

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 Plant and Equipment Risk Management Form
Hazards Inspected Risk Assessment Description of Risk Control Measures
 Other may lead to an accident. management controls have
been implemented. For
example:
 Designated and marked
pedestrian paths (e.g.
painted walkways,
bollards/fenced
walkways etc.)
 Pedestrian no go zones
 High visibility clothing is
worn by
operator/persons in the
work area
 Signs and barricades to
be installed to warn
other employees/
Y N persons in area
 A documented Traffic
Management Plan is in
place
 Relevant employees
have attended traffic
management training.

Ensure forklift is fitted with

appropriate safety features. For
example:
 “Dead Man’s”
control/emergency stop
 Park brake
 Seatbelt
 Rollbar/cage and
 Reversing alarm.

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 Plant and Equipment Risk Management Form
Hazards Inspected Risk Assessment Description of Risk Control Measures
Cons Like Risk
Level
SHEARING Severe Rare Medium Forklift/pedestrian Establish a Traffic Management
Can anyone’s body parts be sheared interaction could lead to a Plan.
between two parts of plant, or between a person being trapped
part of the plant and a work piece or Y N between the forklift and Ensure appropriate traffic
structure? another object. management controls are in
place (refer to cutting and
impact injuries section).
PRESSURISED CONTENT
Can anyone come into contact with fluids or
Y N
gases under high pressure, due to plant
failure or misuse of the plant?
ELECTRICITY Damaged or frayed Operator to check for damaged
Can anyone be injured or burnt due to: electrical cords or electrical components prior to
 Live electrical conductors? (e.g. exposed components would pose use as part of a Pre Start
Y N an electrical hazard. Check.
wires)
 Working in close proximity to electrical
Y N Ensure equipment is serviced
conductors?
 Access to electricity? on a regular basis, tested &
Y N tagged and appropriate isolation
procedures (e.g. lock out tags)
 Damaged or poorly maintained electrical Severe Rare Medium
Y N are in place.
leads, cables or switches?
 Water near electrical equipment?
Y N
 Lack of isolation procedures?
Y N
 Other
Y N

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 Plant and Equipment Risk Management Form
Hazards Inspected Risk Assessment Description of Risk Control Measures
Cons Like Risk
Level
ERGONOMICS Operating the forklift for Ensure the forklift is not
Can anyone be injured due to: extended periods of time operated for extended periods
 Poorly designed workstation? Moderate Possible Medium or poorly designed or of time.
Y N degraded seats may
 Repetitive body movement? Moderate Possible Medium cause musculoskeletal Ensure appropriate rest breaks
Y N injury. are taken.
 Constrained body posture or the need
Y N Ensure forklift seating is in good
for excessive effort?
 Design deficiency causing psychological condition and can be adjusted
Y N for different body types.
stress?
 Inadequate or poorly placed lighting?
Y N
 Does the plant impact on the
surrounding workplace and create
potential hazards? (Consider potential Y N
impact on the design and layout of the
workplace)
 Is the location of the plant inappropriate?
(Consider potential effects due to Y N
environmental conditions and terrain)
 Other
Y N

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 Plant and Equipment Risk Management Form
Hazards Inspected Risk Assessment Description of Risk Control Measures
Cons Like Risk
Level
RADIATION
Can anyone using the plant, or in the vicinity
of the plant suffer injury or illness due to
exposure to radiation in the form of any of
the following: Y N
 infra-red radiation
 ultra violet light
 microwaves
NOISE Moderate Unlikely Medium Operation of the forklift Appropriate hearing protection
Can anyone using the plant, or in the vicinity could result in high noise should be worn whilst operating
Y N
of the plant, suffer injury due to exposure to levels. the equipment (if required).
noise?
VIBRATION
Can anyone be injured or suffer ill health Y N
from exposure to vibration?
FRICTION
Can anyone be burnt due to contact with
Y N
moving parts, materials or surfaces of the
plant?
SUFFOCATION
Can anyone be suffocated due to lack of Y N
oxygen, or atmospheric contamination?
CONDITION
Is a hazard likely due to the age and
condition of the plant? (Consider how hard Y N
the machine has been worked, and whether
it is used constantly or rarely).
 Can anyone be injured as a result of the
plant not serviced appropriately and/or
Y N
maintained in line with manufacturer’s
recommendations?

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 Plant and Equipment Risk Management Form
Hazards Inspected Risk Assessment Description of Risk Control Measures
Cons Like Risk
Level
SLIPS/TRIPS/FALLS Access and egress to the Ensure operator wears slip
Can anyone using the plant, or in the vicinity forklift could pose a risk resistant footwear to reduce risk
of the plant, slip, trip or fall due to: of slip, trip or fall. of slips/falls.
 Uneven, slippery or steep work Major Rare Medium
Y N
surfaces? Poor housekeeping could Ensure operator maintains three
 Poor housekeeping, e.g. spillage in the Moderate Possible Medium result in a slip, trip or fall points of contact when
Y N
vicinity? hazard. accessing or exiting the vehicle.
 Obstacles being placed in the vicinity of Moderate Possible Medium
Y N
the plant? Ensure good housekeeping
 Inappropriate or poorly maintained floor Major Rare Medium practices are maintained
or walking surfaces (i.e. lack of a slip- throughout the work area.
Y N
resistant surface, unprotected holes,
penetrations or gaps?)
If operating or maintaining plant at height
can anyone slip, trip or fall due to:
 Use of work platforms, stairs or ladders?
Y N
 Lack of guardrails or other suitable edge
Y N
protection?
 Other
Y N

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 Plant and Equipment Risk Management Form
Hazards Inspected Risk Assessment Description of Risk Control Measures
Cons Like Risk
Level
FIRE AND EXPLOSION
Y N
Can anyone be injured by fire?
 Can anyone be injured by explosion of
gases, vapours, liquids, dusts, or other Y N
substances?
TEMPERATURE/MOISTURE
Can anyone come into contact with objects Y N
at high or low temperatures?
 Can anyone suffer ill health due to
Y N
exposure to high or low temperatures?
 Can anyone be injured or suffer ill health
Y N
due to exposure to moisture?
OTHER
Can anyone be injured or suffer ill health
from exposure to:
 Chemicals? Y N
 Toxic gases or vapours? Y N
 Fumes / Dusts? Y N
 Other? (please specify) Y N
4. Risk Assessment Signoff
Authorised By: Signature: Date:

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 Plant and Equipment Risk Management Form

1. Consequence - Evaluate the consequences of a risk occurring according 2. Likelihood - Evaluate the likelihood of an incident occurring according to the
to the ratings in the top row ratings in the left hand column
Descriptor Level Definition
Descriptor Level Definition

Rare 1 May occur somewhere, sometime (“once in a life time /

Insignificant 1 No injury once in a hundred years”)

Minor 2 Injury/ ill health requiring first aid Unlikely 2 May occur somewhere within the Department over an
extended period of time
Moderate 3 Injury/ill health requiring medical
attention Possible 3 May occur several times across the Department or a
region over a period of time
Major 4 Injury/ill health requiring hospital
admission Likely 4 May be anticipated multiple times over a period of time
May occur once every few repetitions of the activity or
Severe 5 Fatality event

Almost 5 Prone to occur regularly

3. Risk level - Calculate the level of risk by finding the intersection between the Certain It is anticipated for each repetition of the activity of event
likelihood and the consequences

4. Risk Level/Rating and Actions

Likelihood Consequence
Insignificant Minor Moderate Major Severe Descriptor Definition
Almost Medium High Extreme Extreme Extreme
Certain
Likely Medium Medium High Extreme Extreme Extreme: Notify Workplace Manager and/or Management OHS
Possible Low Medium Medium High Extreme Nominee immediately. Corrective actions should be taken
Unlikely Low Low Medium Medium High immediately. Cease associated activity.
Rare Low Low Low Medium Medium High: Notify Workplace Manager and/or Management OHS
Nominee immediately. Corrective actions should be taken
within 48 hours of notification.
Medium: Notify Nominated employee, HSR / OHS Committee.
Nominated employee, OHS Representative / OHS Committee
is to follow up that corrective action is taken within 7 days.
Low Notify Nominated employee, HSR / OHS Committee.
Nominated employee, HSR / OHS Committee is to follow up
that corrective action is taken within a reasonable time.

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