No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Page Number: 1 of 8
Last Reviewed: January 2015
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
1. Hazard Management Details – General
Plant/Equipment Item:
VACUUM CLEANER
School / Work Location:
Make/Model No.:
Serial No.:
Region:
Name of Person(s) Conducting Activity:
Date Conducted:
Description of use:
Summary of key risks:
A vacuum cleaner uses an electric motor to
create suction (vacuum) to lift dirt, dust and
other waste material into a container or bag
inside the cleaner.

Electricity

Ergonomics

Slips/trips/falls

Other (dust)
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Page Number: 2 of 8
Last Reviewed: January 2015
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
2. Documentation
Relevant Legislation/Standards
Is plant required to be registered?
Y/N
Y
N
Is a user license required?
Y
N
Key reference material:
Plant Documentation
Comments
Are operator’s manuals accessible?
Y/N
Y
N
Is this a restricted use item?
Y
N
Does this item require safe use documents/test?
Y
N
AS4024.1 Safety of machinery
AS/NZS 3760 In service safety inspection and testing of electrical equipment
Comments
3. Hazard Identification
Hazards Inspected
Risk Assessment
Cons
ENTANGLEMENT
Can anyone’s hair, clothing, gloves, cleaning brushes,
tools, rags or other materials become entangled with
moving parts of the plant or materials?
Y
Like
Description of Risk
Control Measures
Description of Risk
Control Measures
Risk
Level
N
Hazards Inspected
Risk Assessment
Cons
Like
Risk
Level
IMPACT AND CUTTING INJURIES
Can anyone be crushed/cut/struck etc. due to:

Material falling off the plant?
Y
N

Uncontrolled/unexpected movement of plant/load?
Y
N
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Page Number: 3 of 8
Last Reviewed: January 2015
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
Hazards Inspected
Risk Assessment

Lack of capacity to slow, stop or immobilize plant?
Y
N

The plant tipping or rolling over?
Y
N

Parts of the plant disintegrating or collapsing?
Y
N

Contact with moving parts during testing, inspection,
operation, maintenance, cleaning or repair?
Y
N

Being thrown off or under the plant?
Y
N

Y
N

Contact with sharp or flying objects? (e.g. work
pieces being ejected)
The mobility of the plant?
Y
N

Inappropriate parts and accessories being used?
Y
N

Other
Y
N
Hazards Inspected
Risk Assessment
Cons
SHEARING
Can anyone’s body parts be sheared between two parts
of plant, or between a part of the plant and a work piece
or structure?
PRESSURISED CONTENT
Can anyone come into contact with fluids or gases under
high pressure, due to plant failure or misuse of the
plant?
ELECTRICITY
Can anyone be injured or burnt due to:
Description of Risk
Y
N
Y
N
Like
Description of Risk
Control Measures
Control Measures
Risk
Level
Damaged or frayed electrical
cords pose an electrical hazard.
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Operator to check for damaged
electrical cords prior to use.
No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Page Number: 4 of 8
Last Reviewed: January 2015
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
Hazards Inspected

Live electrical conductors? (e.g. exposed wires)

Working in close proximity to electrical conductors?

Access to electricity?

Damaged or poorly maintained electrical leads,
cables or switches?

Water near electrical equipment?

Lack of isolation procedures?

Other
Risk Assessment
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Major
Unlikely
Medium
Major
Possible
High
Major
Rare
Medium
Hazards Inspected
Like

Repetitive body movement?

Constrained body posture or the need for excessive
effort?

Design deficiency causing psychological stress?
Y
N
Y
N
Y
N
Y
N
Description of Risk
The use of the vacuum cleaner
may involve repetitive body
movements and awkward
positions.
Minor
Possible
Control Measures
Risk
Level
ERGONOMICS
Can anyone be injured due to:
Poorly designed workstation?
Control Measures
Ensure equipment is serviced on a
regular basis, tested and tagged
and appropriate isolation
procedures (e.g. lock out tags) are
in place.
Risk Assessment
Cons

Description of Risk
Medium
The electric lead or extension
cord may pose a slip/trip hazard.
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Take regular breaks if the task
entails long duration time.
Undertake task during times of low
pedestrian traffic. (e.g. outside
school hours).
No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Page Number: 5 of 8
Last Reviewed: January 2015
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
Hazards Inspected

Inadequate or poorly placed lighting?

Does the plant impact on the surrounding workplace
and create potential hazards? (Consider safe access
and egress from plant, workflow and design of the
workplace)
Is the location of the plant inappropriate? (Consider
potential effects due to environmental conditions and
terrain)
Other


Risk Assessment
Y
Control Measures
Description of Risk
Control Measures
N
Minor
Y
N
Y
N
Y
N
Hazards Inspected
Possible
Medium
Risk Assessment
Cons
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:
 infra-red radiation
 ultra violet light
 microwaves
NOISE
Can anyone using the plant, or in the vicinity of the plant,
suffer injury due to exposure to noise?
VIBRATION
Can anyone be injured or suffer ill-health from exposure
to vibration?
FRICTION
Can anyone be burnt due to contact with moving parts,
materials or surfaces of the plant?
Description of Risk
Y
N
Y
N
Y
N
Y
N
Like
Risk
Level
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Page Number: 6 of 8
Last Reviewed: January 2015
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
Hazards Inspected
SUFFOCATION
Can anyone be suffocated due to lack of oxygen, or
atmospheric contamination?
CONDITION
Is a hazard likely due to the age and condition of the
plant? (Consider how hard 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 maintained in line with
manufacturer’s recommendations?
Y
N
Y
N
Y
N
Hazards Inspected
Risk Assessment
Description of Risk
Control Measures
Risk Assessment
Description of Risk
Control Measures
Cons
SLIPS/TRIPS/FALLS
Can anyone using the plant, or in the vicinity of the plant,
slip, trip or fall due to:
 Uneven, slippery or steep work surfaces?

Poor housekeeping, e.g. spillage in the vicinity?

Obstacles being placed in the vicinity of the plant?
Y
N
Y
N
Y
N
Y
N
Y
N

Inappropriate or poorly maintained floor or walking
surfaces (i.e. lack of a slip-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?
Like
Risk
Level
Minor
Unlikely
Low
Minor
Unlikely
Low
Minor
Unlikely
Low
Minor
Unlikely
Low
Minor
Possible
Medium
The electrical cord may
introduce a slip trip or fall hazard
to the work environment.
Operator to inspect work
environment for hazards prior to
commencing work.
Wet floors or object in work site
may pose a slip, trip or fall
hazard.
Operator to ensure electric lead is
appropriately placed to avoid
creating a trip hazard.
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Undertake task during times of low
pedestrian traffic. (e.g. outside
school hours).
No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Page Number: 7 of 8
Last Reviewed: January 2015
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
Hazards Inspected

Lack of guardrails or other suitable edge protection?

Other
Y
N
Y
N
Hazards Inspected
Risk Assessment
Description of Risk
Control Measures
Risk Assessment
Description of Risk
Control Measures
Cons
FIRE AND EXPLOSION
Can anyone be injured by fire?

Can anyone be injured by explosion of gases,
vapours, liquids, dusts, or other substances?
TEMPERATURE/MOISTURE
Can anyone come into contact with objects at high or
low temperatures?
 Can anyone suffer ill-health due to exposure to high
or low temperatures?
 Can anyone be injured or suffer ill-health due to
exposure to moisture?
OTHER
Can anyone be injured or suffer ill-health from exposure
to:
 Chemicals?
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N

Toxic gases or vapours?
Y
N

Fumes/Dusts?
Y
N

Other? (please specify)
Y
N
Like
Risk
Level
The operator may be exposed to
inhalation of dust particles when
emptying container or bag
containing dust.
Minor
Possible
Medium
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Empty the vacuum cleaner in an
outdoor environment or an area
with adequate ventilation.
Select a vacuum cleaner with
HEPA (High Efficiency Particulate
Air) filter system.
No: DEE ESWB-10-2-2
Authorised By: Manager ESWB
Title: Plant and Equipment Risk Management Form
Issue Date: April 2011
Last Reviewed: January 2015
Page Number: 8 of 8
CENTRAL OFFICE USE ONLY
Next Review Date: May 2015
4. Risk Assessment Signoff
Authorised By:
Signature:
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Date: