SAFE WORK PROCEDURE
Activity/Task:
SWP No:
Trim No:
Version No:
Date Signed Off:
Approved: Yes / No
RISK IDENTIFICATION AND CONTROLS:
Please include all steps involved in the performance of the task
NOTE: All PPE required must be listed and the minimum PPE for each chemical must be listed as per the relevant SDS.
PROCEDURE STEPS
1.
Scope:
2.
Objectives:
3.
References:
4.
Timing:
Safe Work Procedure
Version 1: Sept 2012
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5.
Responsibilities:
6. In the event of: (emergency or other)
7. Location:
8. Training Requirements:
9. Plant and Equipment Details:
10. Engineering Details, Certificates, Work Cover Approvals:
11. Maintenance Requirements:
Safe Work Procedure
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12. Task/Activity Steps:
1:
Possible Hazards:
Safety Controls:
Risk Score:
Safety Controls:
Risk Score:
Safety Controls:
Risk Score:
Safety Controls:
Risk Score:
Safety Controls:
Risk Score:
Safety Controls:
Risk Score:
Safety Controls:
Risk Score:
Safety Controls:
Risk Score:
2:
Possible Hazards:
3:
Possible Hazards:
4:
Possible Hazards:
5:
Possible Hazards:
6:
Possible Hazards:
7:
Possible Hazards:
8:
Possible Hazards:
Safe Work Procedure
Version 1: Sept 2012
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SAFE WORK PROCEDURE:
Assessment dates
Initial assessment date:
Current assessment date:
Reassessment due date:
Assessors:
Name:
Signature:
Date:
Recommendation: (Technical Officer/Supervisor/Manager)
Follow up required: Yes / No
Name:
Date:
Signature:
Approval: (Facility Manager, Head of School, Manager University Laboratories)
Name:
Safe Work Procedure
Version 1: Sept 2012
Signature:
Date:
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Risk Assessment Matrix:
Evaluate the level of risk associated with the hazard identified.
SEVERITY
LIKELIHOOD
How severely could it hurt someone
How likely is it to be that bad?
or
How ill could it make someone?
!!!! Kill or cause permanent
disability or ill health
++
+
-
--
Very likely
Could happen at any time
Likely
Could happen sometime
Unlikely
Could happen, but very
rarely
Very unlikely
Could happen, but probably
never will
1
1
2
3
!!!
Long term illness or serious injury
1
2
3
4
!!
Medical attention and several days
off work
2
3
4
5
!
First aid needed
3
4
5
6
Safe Work Procedure
Version 1: Sept 2012
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I have read and understand this Safe Work Procedure:
Name:
Safe Work Procedure
Version 1: Sept 2012
Position/Role:
Signature:
Date:
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