7/25/2019 Risk Assessment Template (P1.9)

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RISK ASSESSMENT RECORDING FORMLocation orAddress: Priestley collage P!"

Date Assess#ent$nderta%en: &'((&)'

Assess#ent *nderta%en+y: O,en %ing

Acti-ity orSit*ation: editing

Re-ie,Date:

Signat*re

./ 0a1ard Ris% .&/ 23o #ig3t 4e 3ar#ed and 3o,5 .6/ 23at controls e7ist to red*ceris%

(4) 23at action can 4e ta%en

To 8*rt3er red*ce ris%5Falling over wires.

Falling over chairs.

Eye strain

Seizure

A1B2

A1B2

A1B2

A4B3

Crew member might all overtangle! wires.

Crew member might all over chairs.

Crew members" eyes might strain byloo#ing at a screen too long.

Crew member may have a seizureby loo#ing at lashing lights.

$se wire ties to %revent the wirestangling.

&ull all chairs un!er the !es#s%ro%erly.

'a#e brea#s between e!iting.

(a#e the room a bright area.

.%lacing all the wires un!er the!es#s an! tables.

(a#e sure no one runs near thechairs.

&lace a screen ilter to !im thescreen.

(a#e sure crew members !on"tloo# at lashes !irectly.

1. )ist hazar!s so#et3ing ,it3 t3e 9otential to ca*se 3ar# here*See# to +uantiy the level o ris# t3e li%eli3ood o8 3ar# arising base! on the number o %ersons aecte!, how oten they are e-%ose! to the hazar! an! theseverity o any conse+uence.

2. )ist grou%s o %eo%le who are es%ecially at ris# rom the signiicant hazar!s which you have i!entiie!3. )ist e-isting controls here or note where the inormation may be oun!

4. )ist the ris#s which are not a!e+uately controlle! an! the action you will ta#e. ave regar! or the level o ris#, the cost o any action an! the beneit you e-%ect togain.

RISK RATING

a SEERIT; 4 LIKELI0OOD c FINAL SCORE RATING: ,3at needs to 4e done

< Dying or 4eing 9er#anently disa4led < 2ill al#ost certainly 3a99en '=&< Sto9> Do not start acti-ity again *ntil ris% iscontrolled

? Serio*s in@*ry(long ter# illness ? 0ig3ly li%ely to 3a99en )=< 0ig3 ris% le-el 0ig3 9riority! Ta%e action

7/25/2019 Risk Assessment Template (P1.9)

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straig3t a,ay to control t3e ris%6 Te#9orary disa4ility(6 days o88 sic% 6 Not so li%ely '=" Medi*# ris% le-el! Tig3ten *9 controls and

#a%e a 9lan to do so#et3ing a4o*t ris%& 2ill need #edical attention & E-en less li%ely 6=< Fairly lo, ris% le-el! Lo, 9riority 4*t %ee9

9ossi4le action in #ind Minor in@*ry eg! +r*ise gra1e $nli%ely to 3a99en at all =& Lo, or tri-ial ris%! No 8*rt3er action

reB*ired!

SO: a 7 4 c

Action ReB*ired Res9onsi4le Person Date 8or Co#9letion