FORM A: RISK ASSESSMENT
(Please attach map or other notes if this helps)
SHEET NUMBER
e.g.
1
of
of 3
This form is for staff or volunteers responsible for a Trust site or a Trust activity. You have a responsibility to assess the risks and undertake precautions
which reduce significant risks. This form is to help with your assessment and is designed to show how your precautions reduce any risks.
Name of site …All………………………………………... Date of assessment 23/1/12 …………….. Assessed by laura harvey
Are you undertaking this assessment for a whole site or a particular activity? Please specify …. Constructing bird boxes…………………………………
Risk of injury
Description of hazard
Who is at risk?
Severity
Likelihood:
of injury: high/med/
high/med/ low
low
Precautions needed to reduce risks
Risk of injury with
precautions
Severity
Likelihood:
of injury:
high/med
high/med/ / low
low
Cuts, grazes, scratches, bruises or
splinters to hands
All
Med
Med
Safety talk/demonstration/all to wear
protective gloves
Low
Low
Trips, slips and falls.
All
Med
Med
Low
Safety talk, tools and equipment to be
placed to avoid obstruction. Operators to be
widely spaced.
Low
Harm caused by use of nails and
hammer
Operator and those
around
Low
Med
Demonstration/ operation. Operator to wear
glove on hand holding nail with and work in
designated area.
Low
Med
All
Med
Med
Children to be well supervised and to work
spaced out well.
Low
Low
Low
Those lifting items or
those nearby.
Med
Only adults to lift heavy items and to plan
operations. Training in and use of correct
lifting techniques.
Low
Med
Saw dust in eyes
Injury to back or foot through carrying
or dropping a heavy item.
Revised Jan 2006
Please copy blank forms as needed. Please return completed forms to your Line Manager. A copy will be sent back to you with any comments.
Revised Jan 2006