Tool Inspection Report

 

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Tool Hazard and Risk Assessment

OWNER/INSPECTION DETAILS

Inspection #[inspection:inspection_number]

Date of Inspection[inspection:inspection_date]
Provided for[inspection:provided_for]
Tool Make & Model[inspection:vehicle_year] [inspection:vehicle_make] [inspection:vehicle_model]
Identification No.s[inspection:vehicle_registration] 
Inspection Done at[inspection:inspection_locale]
[inspection:asset_image]
Assessment Conducted By 
Steersafe Training and Assessment ABN 84 137 032 681 
Scott Haynes 
Certificate IV Training & Assessment TAA40104 
Certificate No 1678 
Phone: 0418 536 870 
 

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CONTENTS

OWNER DETAILS1
ACKNOWLEDGMENT AND AGREEMENT3
RISK MATRIX & HIERARCHY OF CONTROLS4
TOOL HAZARD & RISK ASSESSMENT5
NOISE ASSESSMENT10
OPERATOR ACKNOWLEDGEMENT11
DISCLAIMER12

 

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AGREEMENT

THIS AGREEMENT is made on [inspection:inspection_date_agreement]

and is made between:

SCOTT HAYNES of Steersafe Training and Assessment, and

[inspection:customer_representative] of [inspection:provided_for]

The owner/operator agrees to engage Scott Haynes to perform Risk Assessment on the basis of agreement to the following disclaimer.

DISCLAIMER

"Tool" means the device or equipment described in the assessment and inspected by the assessor.

This assessment is based upon information provided to the assessor up until the date of the assessment. If any modification, alteration or addition is made to the tool following that date, this assessment is null and void and cannot be relied upon for any purpose. In particular, this assessment will then provide no assurance that the tool complies with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. The owner and operator of the tool must conduct regular inspections and maintain the tool at regular intervals. If any alteration or addition is made to the tool, such alterations or additions must be recorded in writing and retained by the owner and operator. The tool will then need to be re-assessed.

At all times it is the responsibility of the owner and operator of the tool to maintain the tool according to the Occupational Health and Safety Regulations 2017 and all other applicable legislation and regulations. The assessor is not and shall not be liable for the tool complying with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. This assessment does not pass any responsibility for such compliance to the assessor, and does not in any way exempt the owner and operator from the continuing responsibility for such compliance. The owner and operator agree to indemnify the assessor against all liability of whatever kind in relation to the tool assessed.

This assessment will be conducted by a qualified workplace assessor. This assessment will not be conducted by a qualified mechanic nor a roadworthy assessor, and no responsibility is assumed by the assessor for any mechanical malfunction of the tool.

This assessment identifies risks in relation to the tool only, and does not assess risks in relation to the site where the tool is to be used. A job safety and environmental analysis is required to identify such site risks and should be reviewed by the owner and operator prior to commencement of work on site.  

ACKNOWLEDGEMENT AND AGREEMENT

I confirm that I have read and understood the disclaimer and notes set out about and agree with all terms

Name: [inspection:customer_representative]                 

Company/Organization: [inspection:provided_for]		Signed:[inspection:customer_signature] 
Date: [inspection:inspection_date]  

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RISK MATRIX

Risk Matrix

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TOOL HAZARD & RISK ASSESSMENT

HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. CRUSHING                              
    Can anyone be crushed by:
(a) the tool tipping or rolling overH

I

G

H		Dead man's switch and/or E-stops in place[inspection:tool_deadman][inspection:tool_deadman_issues]M

E

D

I

U

M

(b) being trapped between two parts of the tool

 

Regular maintenance of tool as recorded

 

[inspection:tool_maintenance]

 

 

[inspection:tool_maintenance_issues]

Tool attached to solid surface where possible

 

[inspection:tool_attached]

 

[inspection:tool_attached_issues]

 

Decals fitted

 

[inspection:tool_decals]

 

[inspection:tool_decals_issues]

 

Minimise number of people in work area[inspection:tool_people][inspection:tool_people_issues]

(c) any other factors not mentioned

 

 [inspection:tool_crushing_other][inspection:tool_crushing_other_issues]
  1. SHEARING      
    Can anyone's body parts be cut off or sheared:
(a) by parts of the toolH

I

G

H		Decals fitted[inspection:tool_decals][inspection:tool_decals_issues]M

E

D

I

U

M
Guards fitted as required[inspection:tool_guards][inspection:tool_guards_issues]
(b) by work pieces 
disintegrating or 
being ejected		Dead man's switch and/or E-stops in place[inspection:tool_deadman][inspection:tool_deadman_issues]
Correct tight-fitting PPE worn[inspection:tool_ppe][inspection:tool_ppe_issues]
Minimise number of people in work area[inspection:tool_people][inspection:tool_people_issues]
(c) any other factors not mentioned [inspection:tool_shearing_other][inspection:tool_shearing_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. STRIKING   
    Can anyone be struck by moving objects due to:
(a) the tool or equipment being worked on disintegratingM

E

D

I

U

M		Decals fitted[inspection:tool_decals][inspection:tool_decals_issues]L

O

W
 
Controls/levers identified[inspection:tool_controls_levers][inspection:tool_controls_levers_issues]
Regular maintenance of tool as recorded[inspection:tool_maintenance][inspection:tool_maintenance_issues]
Guards fitted as required[inspection:tool_guards][inspection:tool_guards_issues]
Correct tight-fitting PPE worn[inspection:tool_ppe][inspection:tool_ppe_issues]
Minimise number of people in work area[inspection:tool_people][inspection:tool_people_issues]
(b) any other factors not mentioned [inspection:tool_striking_other][inspection:tool_striking_other_issues]
  1. ENTANGLEMENT   
    Can anyone be injured by:
(a) hair, clothing or any other items they are wearing or attached to them, become entangled in the moving parts of the tool?M

E

D

I

U

M		Guards fitted as required[inspection:tool_guards][inspection:tool_guards_issues]L

O

W
 
Warning decals for moving parts[inspection:tool_entanglement_decals][inspection:tool_entanglement_decals_issues]
Correct tight-fitting PPE worn[inspection:tool_ppe][inspection:tool_ppe_issues]
(b) any other factors not mentioned [inspection:tool_entanglement_other][inspection:tool_entanglement_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. CUTTING, STABBING & PUNCTURING   
    Can anyone be injured by:
(a) contact with sharp or moving parts on the toolM

E

D

I

U

M		Guards fitted as required[inspection:tool_guards][inspection:tool_guards_issues]L

O

W
 
Decals fitted[inspection:tool_decals][inspection:tool_decals_issues]
(b) the tool or equipment being worked on disintegratingCorrect PPE worn[inspection:tool_ppe][inspection:tool_ppe_issues]
(c) uncontrolled or unexpected movement of the toolRegular maintenance of tool as recorded[inspection:tool_maintenance][inspection:tool_maintenance_issues]
Dead man's switch and/or E-stops in place[inspection:tool_deadman][inspection:tool_deadman_issues]
Minimise number of people in work area[inspection:tool_people][inspection:tool_people_issues]
(d) any other factors not mentioned [inspection:tool_cutting_other][inspection:tool_cutting_other_issues]
  1. ELECTRICAL         
    Can anyone be injured or burnt from electrical shock by:
(a) exposed and damaged battery or leadsM

E

D

I

U

M		Guards around battery or wiring[inspection:tool_electrical_guards][inspection:tool_electrical_guards_issues]L

O

W
 
Regular maintenance of tool as recorded (annual test and tag completed)[inspection:tool_maintenance][inspection:tool_maintenance_issues]
Decals fitted[inspection:tool_decals][inspection:tool_decals_issues]
(b) damaged electrical wiring, switches or cablesMinimise number of people in work area[inspection:tool_people][inspection:tool_people_issues]
(c) any other factors not mentioned [inspection:tool_electrical_other][inspection:tool_electrical_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. BURNS         
    Can anyone be burnt by:
(a) contact with exhaustM

E

D

I

U

M		Guards around exhaust[inspection:tool_exhaust_guards][inspection:tool_exhaust_guards_issues]L

O

W
 
Decals fitted[inspection:tool_decals][inspection:tool_decals_issues]
Exhaust mounted away from easy access[inspection:tool_exhaust_inaccessible][inspection:tool_exhaust_inaccessible_issues]
(b) fire in the toolRegular maintenance of tool as recorded[inspection:tool_maintenance][inspection:tool_maintenance_issues]
Fire extinguisher supplied near tool[inspection:tool_fire_extinguisher][inspection:tool_fire_extinguisher_issues]
(c) any other factors not mentioned [inspection:tool_burns_other][inspection:tool_burns_other_issues]
  1. HIGH PRESSURE AND EXPLOSION         
    Can anyone be injured by:
(a) high pressure fluidM

E

D

I

U

M		Regular maintenance of hydraulic hoses and couplings as recorded[inspection:tool_hydraulic_maintenance][inspection:tool_hydraulic_maintenance_issues]L

O

W
 
(b) explosions caused by gas, vapours, liquids or other substancesAll seals and tanks in good working order[inspection:tool_seals][inspection:tool_seals_issues]
(c) any other factors not mentioned [inspection:tool_pressure_other][inspection:tool_pressure_other_issues]
  1. OTHER HAZARDS         
    Can anyone be injured or become ill from:
(a) excessive noiseM

E

D

I

U

M		Hearing protection supplied         
N.B. See noise level test for more detail		[inspection:tool_hearing_protection][inspection:tool_hearing_protection_issues]L

O

W
 
(b) vibrationRest periods to be taken[inspection:tool_vibration][inspection:tool_vibration_issues]
(c) any other factors not mentioned [inspection:tool_misc_other][inspection:tool_misc_other_issues]

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HazardInitial RiskControlControl in placeAction RequiredResidual Risk
  1. DOCUMENTATION         
    Has information been provided on the following:
(a) daily pre start inspection check listM

E

D

I

U

M		Pre start provide[inspection:tool_pre_start][inspection:tool_pre_start_issues]L

O

W
 
(b) service and maintenance recordsService history provided[inspection:tool_maintenance_records][inspection:tool_maintenance_records_issues]
(c) tool operation manualTool Manual provided[inspection:tool_operators_manual][inspection:tool_operators_manual_issues]

NOTE 

High risk denotes a possible or probable occurrence and possible death, or life threatening injury, or permanent disability without the use of controls.  
Medium risk denotes unlikely or possible occurrence and possible injury without the use of controls. [inspection:page_break]

NOISE ASSESSMENT

The noise level reading shall be taken at exhaust level, and within 1050mm of the exhaust emission. The reading will be taken at idle and at “Engine Speed at Maximum Power”. This procedure is in accordance with the Environment Protection (Vehicle Emissions) Regulations 2003.

A further reading shall then be taken from the tool.

The sound meter used for this assessment is a Digitech QM-1589, Serial No 10060748 in accordance with the Environment Protection (Vehicle Emissions) Regulations 2003.

Tool Details[inspection:vehicle_year] [inspection:vehicle_make] [inspection:vehicle_model]
Identification No.[inspection:vehicle_registration]
Background Noise[inspection:background_noise]
Noise During Operation[inspection:noise_power]

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OPERATOR ACKNOWLEDGMENT 

Operator to read this risk assessment report and complete and sign below. 

I have read and understood this risk assessment report and confirm that I hold the required qualifications to operate the assessed tool.

Operator Full NameOperator QualificationOperator SignatureDate Signed

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

 

 

   

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DISCLAIMER

“Tool” means the tool or equipment described in the assessment and inspected by the assessor.

This assessment is based upon information provided to the assessor up until the date of the assessment. If any modification, alteration or addition is made to the tool following that date, this assessment is null and void and cannot be relied upon for any purpose. In particular, this assessment will then provide no assurance that the tool complies with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. The owner and operator of the tool must conduct regular inspections and maintain the tool at regular intervals. If any alteration or addition is made to the tool, such alterations or additions must be recorded in writing and retained by the owner and operator. The tool will then need to be re-assessed.

At all times it is the responsibility of the owner and operator of the tool to maintain the tool according to the Occupational Health and Safety Regulations 2017 and all other applicable legislation and regulations. The assessor is not and shall not be liable for the tool complying with the Occupational Health and Safety Regulations 2017 or any regulation amending or replacing those regulations. This assessment does not pass any responsibility for such compliance to the assessor, and does not in any way exempt the owner and operator from the continuing responsibility for such compliance. The owner and operator agree to indemnify the assessor against all liability of whatever kind in relation to the tool assessed.

This assessment has been conducted by a qualified workplace assessor. This assessment was not conducted by a qualified mechanic nor a roadworthy assessor, and no responsibility is assumed by the assessor for any mechanical malfunction of the tool.

This assessment identifies risks in relation to the tool only, and does not assess risks in relation to the site where the tool is to be used. A job safety and environmental analysis is required to identify such site risks and should be reviewed by the owner and operator prior to commencement of work on site.

ACKNOWLEDGMENT AND ACCEPTANCE

I confirm that I have read and understood the disclaimer and notes set out above and agree with all terms.

I also acknowledge I have received the completed Risk Assessment for the aforementioned Tool

Name: [inspection:customer_representative]Company/Organisation: [inspection:provided_for]  
Signed: [inspection:customer_signature]Date: [inspection:inspection_date]