Who will be responsible for implementing the precautions: By When: Completed by: Signed: Record of annual review: Risk Rating: 17-25 Unacceptable – Stop activity and make immediate improvements/seek further advice 10-16 Tolerable – look to improve within specified timescale 5-9 Adequate – Look to improve at next review 1-4 Acceptable - No further action, but ensure controls are maintained Guide to using the risk rating table: Consequences Likelihood 1 Insignificant – no injury 1 Very unlikely – 1 in a million chance of it happening 2 Minor – minor injuries 2 Unlikely – 1 in 100,000 chance of it happening 3 Moderate – up to three days absence 3 Fairly likely – 1 in 10,000 chance of it happening 4 Major – more than three days absence 4 Likely – 1 in 1,000 chance of it happening 5 Catastrophic – death or disabling 5 Very likely – 1 in 100 chance of it happening Physical / Mechanical / Electrical / Biological (Animals) Risk Assessment
Completed by: Signed: Record of annual review: Risk Rating: 17-25 Unacceptable – Stop activity and make immediate improvements/seek further advice 10-16 Tolerable – look to improve within specified timescale 5-9 Adequate – Look to improve at next review 1-4 Acceptable - No further action, but ensure controls are maintained to using the risk rating table: Consequences Likelihood 1 Insignificant – no injury 1 Very unlikely – 1 in a million chance of it happening 2 – minor injuries 2 Unlikely – 1 in 100,000 chance of it happening 3 Moderate – up to three days absence 3 Fairly likely – 1 in 10,000 chance of it happening 4 Major – more than three days absence 4 Likely – 1 in 1,000 chance of it happening 5 Catastrophic – death or disabling 5 Very likely – 1 in 100 chance of it happening
Chemical Risk Assessment (COSHH). No Product / Chemical MSDS present Risk Phrases (R…) Safety Phrases (S…) Flammable/ highly flammable / explosive / oxidising? What precautions are required? What PPE is required? Risk level 1 2 3 4 5 6 7 8 9 10 Enter the product brand name or chemical name. Make sure the MSDS is available in the area in which you are working. These should be on the MSDS These should be on the MSDS Please state which if applicable. E.g. Fume cabinet / specialised storage cabinets / segregation of chemicals. E.g. gloves / goggles / lab coats. Use the table below to calculate this. If any medium, high or critical risks are identified you will need to implement additional control measures to lower the risk. No Product / Chemical Risk level in 1st table What additional precautions are required? Risk 1
List groups of people who could be affected: What numbers of people are involved? What existing precautions are in place to reduce risks? Risk level with existing precautions No. What additional actions are required to ensure precautions are implemented/effective or to reduce the risk further? Risk level with additional precautions No. Is health surveillance required? YES/NO If YES, please detail: Who will be responsible for implementing precautions: By When: Inspection Form Date: Building & room number: Type: Make: Mode: 1 Serial No.: Max Power: Precautions Class 1 Class 1M Class 2 2M Class 3R 3B Class 4 Remote Interlock Key Control Emission indicator Beam Shutter Beam Stop Beam Level