No: DEE ESWB 07-2-4
Authorised By: Manager ESWB
Title: Hazardous Manual Handling Risk Management Form
Issue Date: April 2011
Last Reviewed: July 2013
Next Review Date: July 2015
CENTRAL OFFICE USE ONLY
Page Number: 1 of 8
The Hazardous Manual Handling Risk Management Form should be used to evaluate a task or work area in order to assess the potential for a
manual handling injury to occur. For further information please refer to the Manual Handling Procedure.
Workplace:
Description of task:
Assessors
Management representative:
Health & safety representative:
Others:
Assessment Details
Location of task:
Assessment date:
Reason for identification (tick):
Existing task
Change in task, object, tool
MSD incident report
Describe the task & area (it may be helpful to sketch the task or attach a photograph here)
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
New task
New information
MSD hazard report
No: DEE ESWB 07-2-4
Authorised By: Manager ESWB
Title: Hazardous Manual Handling Risk Management Form
Issue Date: April 2011
Last Reviewed: July 2013
Next Review Date: July 2015
CENTRAL OFFICE USE ONLY
Page Number: 2 of 8
Documentation
Relevant Legislation/Standards/Documentation
Are instruction manuals accessible?
Y/N
Y
Comments
N
Is a Safe Work Procedure (SWP) required to be
Y
N
developed? (complete once risk assessment has been conducted)
Occupational Health and Safety Act 2004, Occupational Health and safety Regulations 2007, Victorian Code of Practice for Manual Handling 2000,
Key reference material:
Hazardous Manual Handling Tasks Draft Code of Practice 2010.
Risk Assessment
Step 1a: Does the task involve repetitive movement or
sustained or awkward postures?
Think about the work area and each stage of the work to be performed.
Does the task involve repetitive (more than twice a minute) movements; or
sustained (more than 30 seconds at a time) postures and/or awkward postures?
Bending the back forwards or sideways more than 5 degrees
Bending the back of head backwards for more than 5 degrees
Bending the head forwards or sideways more than 20 degrees
Twisting the back more than 20 degrees
Twisting the neck more than 20 degrees
Working with one or both hands above shoulder height
Reaching forwards or sideways more than 30 cm from the
body
Reaching behind the body
This action happens when… e.g.
Source of Risk
picking up chemical containers in the chemical
storeroom from ground level.
e.g. chemical containers are stored too low.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Squatting, kneeling, crawling, lying, semi-lying or jumping
Yes
Standing with most of the body’s weight on one leg
Yes
Twisting, turning, grabbing, picking or wringing actions with the
fingers, hands or arms
Yes
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Duration of
task e.g. 5 times
per minute for 3
hours a day
No: DEE ESWB 07-2-4
Authorised By: Manager ESWB
Title: Hazardous Manual Handling Risk Management Form
Issue Date: April 2011
Last Reviewed: July 2013
Next Review Date: July 2015
CENTRAL OFFICE USE ONLY
Working with the fingers close together or wide apart
Yes
Very fast movements
Yes
Excessive bending of the wrist
Yes
Step 1b: Does the task involve any repetitive or sustained
forces?
Page Number: 3 of 8
This action happens when…
Source of Risk
e.g. loading books on to a trolley
e.g. trolley is on the ground
per minute for 3
hours a day
Think about the work area and each stage of the work to be performed.
Does the task involve:

repetitive (more than twice a minute) movements; or

Sustained (more than 30 seconds at a time) postures and/or awkward
postures?
Lifting or lowering
Yes
Carrying with one hand or one side of the body
Yes
Yes
Yes
Yes
Exerting force with one hand or one side of the body
Pushing, pulling or dragging
Exerting force while in an awkward posture e.g. supporting
items while arms or shoulders are in awkward posture
Gripping with the fingers pinched together or held wide
apart
Holding, supporting or restraining any object, person,
animal or tool
Step 2 – Does the task in step 1a or 1b involve long
duration?
More than 2 hours over a whole shift
Yes
Continually for more than 30 minutes at a time
Yes
Duration of
task e.g. 5 times
Yes
Yes
Risk Rating
(refer to Risk Matrix:
Appendix 1)
Conseq
Likel’d
Risk
Level
Risk Control Measures
List the control measures required to eliminate or minimise the risk

Short Term Controls (immediately to within a few weeks)

Medium term controls (within a few weeks to a couple of months)

Long term controls (within several months)
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
No: DEE ESWB 07-2-4
Authorised By: Manager ESWB
Title: Hazardous Manual Handling Risk Management Form
Issue Date: April 2011
Last Reviewed: July 2013
Next Review Date: July 2015
CENTRAL OFFICE USE ONLY
Step 3: Does the task involve high or sudden force?
Tick yes if the task involves any of the following high force
actions, even if force is applied only once.
This action happens
when… e.g. Picking up
and putting boxes down
Page Number: 4 of 8
Source of Risk
e.g. Boxes are heavy and
awkward shape and no
handholds
Applying uneven, fast or jerky forces during lifting,
carrying, pushing or pulling
Applying sudden or unexpected forces (e.g. when
handling a person or animal)
Pushing or pulling objects that are hard to move or
to stop (e.g. a trolley)
Using finger-grip, a pinch-grip or an open-handed
grip to handle a heavy or large load
Exerting force at the limit of the grip span
Needing to use two hands to operate a tool
designed for one hand
Throwing or catching
Hitting or kicking
Holding, supporting or restraining a person, animal
or heavy object
Jumping while holding a load
Exerting force with the non-preferred hand
Two or more people need to be assigned to handle
a heavy or bulky load
Exerting high force while in a bent, twisted or
awkward posture
Risk Control Measures
List the control measures required to eliminate
or minimise the risk

Short Term Controls (immediately to within
a few weeks)

Medium term controls (within a few weeks
to a couple of months)

Long term controls (within several months)
Conseq
If you tick yes to any box in step 3 the task is a risk and
risk control is required.
Lifting lowering or carrying heavy loads
Risk Rating
(refer to Risk Matrix:
Appendix 1)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Likel’d
Risk
Level
No: DEE ESWB 07-2-4
Authorised By: Manager ESWB
Title: Hazardous Manual Handling Risk Management Form
Issue Date: April 2011
Last Reviewed: July 2013
Next Review Date: July 2015
CENTRAL OFFICE USE ONLY
Workers report pain or significant discomfort during
or after the task
The task can only be done for short periods
Stronger workers are assigned to do the task
Workers think the task should be done by more than
one person, or seek help to do the task
Workers say the task is physically very strenuous or
difficult to do
Page Number: 5 of 8
Yes
Yes
Yes
Yes
Yes
Step 4: Are aspects of the work environment
increasing the risk?
This action happens
when… e.g. breaking
Source of Risk
e.g. using a jackhammer
concrete
Tick yes if any of the following environmental factors are
present in the task.
Conseq
If you tick yes to any box in step 4 risk control is
required
Hand-arm vibration
Yes
Whole body vibration
Yes
High temperatures
Yes
Radiant heat
Yes
High humidity
Yes
Low temperatures
Yes
Wearing protective clothing while working in
hot conditions
Wearing thick clothing while working in cold
conditions e.g. gloves
Handling very cold or frozen objects
Yes
Risk Rating
Yes
Yes
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Risk Control Measures
(refer to Risk Matrix:
Appendix 1)
Likel’d
Risk
Level
List the control measures required to
eliminate or minimise the risk

Short Term Controls (immediately to
within a few weeks)

Medium term controls (within a few
weeks to a couple of months)

Long term controls (within several
months)
No: DEE ESWB 07-2-4
Authorised By: Manager ESWB
Title: Hazardous Manual Handling Risk Management Form
Issue Date: April 2011
Last Reviewed: July 2013
Next Review Date: July 2015
Workers are working in hot conditions and are
not used to it
CENTRAL OFFICE USE ONLY
Page Number: 6 of 8
Yes
Step 5: Are aspects of the way work is organised
increasing the risk?
This action happens
when…
Source of Risk
Tick yes if any of the following psychosocial factors are
present in the task.
Risk Control Measures
List the control measures required to
eliminate or minimise the risk
Short Term Controls (immediately to
within a few weeks)
Medium term controls (within a few
weeks to a couple of months)
Long term controls (within several
months)
Conseq
If you tick yes to any box in step 5 risk control is
required
The work rate is set by a machine or team and
not under worker control
Systems of work, such as a piecework, that
encourage workers to skip breaks to finish
early, or to procedure more items in the set
Levels of work demand that workers find it
difficult to keep up with pace
Sustained high levels of attention and
concentration
Systems of work that offers the worker little or
no control over the way they do their work
Workers frequently needing to meet tight
deadlines
Sudden changes of workload or seasonal
changes in volume without any mechanisms
for dealing with change
Levels of physical work demand that works find
Risk Rating
(refer to Risk Matrix:
Appendix 1)
Likel’d
Risk
Level



Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
No: DEE ESWB 07-2-4
Authorised By: Manager ESWB
Title: Hazardous Manual Handling Risk Management Form
Issue Date: April 2011
Last Reviewed: July 2013
Next Review Date: July 2015
CENTRAL OFFICE USE ONLY
Page Number: 7 of 8
difficult to maintain effort
Unsuitable equipment and/or insufficient
staffing levels
Assessment Conducted by:
Yes
Signature
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED
Date:
Appendix 1: Risk Matrix
Likelihood
Descriptor
Level
Definition
Rare
1
May occur only, sometime (“once in a life time / once in a hundred
years”)
Unlikely
2
May occur somewhere within DEECD over an extended period of time
Possible
3
May occur several times across DEECD or a region over a period of time
Likely
4
May be anticipated multiple times over a period of time
May occur once every few repetitions of the activity or event.
Almost
Certain
5
Prone to occur regularly
Is anticipated for each repetition of the activity
Consequence
Descriptor
Level
Definition
Insignificant
1
No injury
Minor
2
Injury/ ill health requiring first aid
Moderate
3
Injury/ill health requiring medical attention
Major
4
Injury/ill health requiring hospital admission
Severe
5
Fatality
Risk level
Likelihood
Almost Certain
Likely
Possible
Unlikely
Rare
Key
Extreme:
High:
Medium:
Low:
Consequence
Insignificant
Medium
Medium
Low
Low
Low
Minor
High
Medium
Medium
Low
Low
Moderate
Extreme
High
Medium
Medium
Medium
Major
Extreme
Extreme
Extreme
Medium
Medium
Severe
Extreme
Extreme
Extreme
High
Medium
Notify Workplace Manager and/or Management OHS Nominee immediately.
Corrective actions should be taken immediately. Cease associated activity.
Notify Workplace Manager and/or Management OHS Nominee immediately.
Corrective actions should be taken within 48 hours of notification
Notify Nominated employee, HSR / OHS Committee. Nominated employee,
OHS Representative / OHS Committee is to follow up that corrective action is
taken within 7 days.
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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