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Company Name

Address.

Village County. Post Code

RISK ASSESSMENT

Contract Title: ?????? / Contract No: F 1 / Date 05/09/06
Work activity / Location : / GAS PIPE WORK at ????
Persons Exposed / Comments (include reference to disabled, trainees, etc.)
Employees / 4
Other workers / N/A
Public / N/A
Hazards Identified / ( Y ) If present/requiring Control / ( N ) if absent/not significant
1) Physical Injury Hazards / Y / N / 2) Physical Agents / Y / N / 4) Manual Handling / Y / N
Mobile Plant / N / Ionising Radiation / N / Manual Handling Injury / Y
Moving parts of machine / N / Lasers / N
Moving Materials / N / Ultraviolet Light / Y / 5) Miscellaneous
Falls from heights / Y / Cold Objects / N / Weather / N
Access Equipment / Y / Hot Objects / Y / Lone Worker / N
Slips, Trips, Falls / Y / Temperature / Y / Confined Spaces / N
Excavations / N / Noise/Vibration / N / Restricted Access / N
Pressurised Systems / Y / 3) Hazardous
Substances
Electrical / N / Hazardous Substances / N / Other / N
Hot Work/Fire / Y / Micro-organisms / N / Other / N
Explosion / Y / Vermin/Weil’s Disease / N / Other / N
Specific Site Conditions / Describe site elements which create specific risks (e.g.. weather conditions for roof work, etc.) which require precautions to be taken during works:
WORKING AT HIGHT. HOT WORK. GAS PURGING. MANUAL HANDLING
Risk Evaluation
Likelihood of Harm (L)
Score 1 if unlikely, 2 if possible or 3 if likely / Severity (S)
Score 1 if minor, 2 if moderate or 3 if serious / Risk Number = LxS
(Scores multiplied)
1) Physical Injury / 2 / 2 / 4
2) Physical Agents / 1 / 1 / 1
3) Hazardous Substances / 1 / 1 / 1
4) Manual Handling / 2 / 1 / 2
5) Miscellaneous
State Key Risks where the risk number is greater than 4.
Control Measures - See Part 2 overleaf
Completed by : ???…………………
Title: …Engineer…………………………………………
Approved by : ???…………………… / Signature: ......
Date: ..05/09/06...... ….
Signature: ………………………………….

DON’T FORGET TO MONITOR AND REASSESS

Ref. No
CONTROL ITEM / DETAILS OF CONTROL MEASURES
Associated Documents
Procedures etc. / Method statement for Installation of gas pipework.
Control Measures
(Include reference to other documentation if applicable) / Isolate gas main. Leak test isolation valves. Nitrogen purge gas pipe work. ???
Specific Training / Personnel to be competent persons. CORGI Registration number ????
Emergencies / ACCIDENT & EMERGENCY. PHONE 999
PPE / Overalls/work gloves. Hard Hat. Safety glasses for grinding / cutting. Steel toe cap boots
Other Procedures / Permit To Work

The above controls have been selected to protect the health and safety of operatives and others that may be affected by the work. The controls have been designed to protect against the risks recorded on Page 1.