FORM No: RM /-1001

Rotary Club of xxxxxxxxxx (SA) Inc.

ISSUE: Revision 2RISK ASSESSMENT

RECORD OF ASSESSMENT
Ref No:?/2017
Venue: / Risk Assessment from worksheet page 2
Committee: / Personal injury / Low
Activity: / Damage to Environment / Low
Assessment Team: / Asset Damage / Low
Reputation / Low
Security / Low
Assessor Name: / Signature:
Date of Assessment: / Date Reviewed:
Responsible person: / Next Review:if required
Phone number / contact/ address
Authorisation of function: Date of Board Minutes?:
Other organisations involved?(1) Joint Functions with other Organisations. Rotary's Insurance Covers all Rotary Clubs and Volunteers working under the auspices of the organising Club. It does not cover THIRD PARTIES such as Councils, Contractors or Stall Holders.
If there are Third Parties involved then they need to show Proof of Insurance via a Certificate of Currency for their Public Liability and Property Cover Ensure the details of the person responsible for the event in that organisation are obtained, (their Name and Address required.)
(2) If you are involved in another event not arranged by your Club please ensure that you have your Club's Certificate of Currency for Public Liability Insurance available. This needs to be in your Club's name.
(3) Ensure that the Insurance Form for Products and Public Liability for Rotary Clubs is completed and forwarded to the District Insurance Officer as soon as possible prior to the event. DO NOT HOLD ONTO ANY PAPERWORK. BUT FORWARD IT AS SOON AS POSSIBLE. / Outside assistance required?: Y/N
Ambulance, Police, Fire Brigade / CFS,
St John’s, Security organizations, council
Rotarians at Risk:
Others Who May Be At Risk:
Public liability Insurance in Place? Y/N / Club Checklist completed? Y/N
Some Clubs may generate a local specific checklist
IF ADDITIONAL CONTROL MEASURES ARE REQUIRED, CAN THEY BE IMPLEMENTED IMMEDIATELY? / Y/N
IF NO, SUMMARISE ACTION PLAN BELOW:
Actions Required: / Target Date / Action By / Completed By
(Name & Date)
Date for Full Implementation of Control Measures:
Assessment Accepted By President:Yes Sign…………………….. Date

Distribution: Copy to accompany the Insurance Form. Original on file.Page 1 of 2

FORM No: GR /-001

Rotary Club of xxxxxxxxxxx (SA) Inc.

ISSUE: Revision 2

RISK ASSESSMENT

Hazards / Risks / S / L / R / Additional Control Measures Required / Residual Risk Rating
S / L / R

S = Severity; L = Likelihood; R = Risk Rating (S x L = R)

Include in the Risk Assessment

1. Is there clear access and egress from the event?
Access for emergency vehicles?
2. Are there emergency evacuation procedures in place? Fire exits clearly marked unlocked, exit signs in place and exit routes unobstructed?
3. Are there handrails provided if &where required?
4. Toilets if provided, signs in place
5. If St Johns Ambulance Service (or equivalentare not in attendance, suitable first aid facilities must be in place. Erect signs.
6. In a building: Is the owner insured? (Property and Public Liability)
Obtain a copy of the insurance certificate? Place it on file.
Check the floors for unevenness, carpets and floor covings for condition and security. Check wet surfaces.
7. The responsible person (or his/her delegate) organising the event should have a list of telephone numbers for emergency services etc. and a mobile phone

Distribution: Copy to accompany the Insurance Form. Original on file.Page 1 of 2