EQUIPMENT RISK ASSESSMENT

RESET FORM

This form can be expanded electronically or extra information (e.g. photos) attached. #:

Department:
Assessment/Equipment Name: Assessment Date: Review Date:
(3 years maximum)
Description of equipment:
Location: Building _________ Room #: ______ Person in charge of the equipment: _________________________
Manufacturer/Make/Model:
Serial no and/or UW Asset No: Purchase date:
Installing company (if applicable) :
Service/calibration contractor (if applicable):
Any relevant regulation, code, standard, guideline or manufacturer handbook (list):

Licensing
Are there any licensing requirements associated with ownership or operation of the equipment? Yes No
E.g.: Ionizing radiation, Biosafety, Laser, X-ray, Cannabis
 Are licenses obtained and displayed? Yes No Permit #:
Risk assessment and Identify hazards (use the checklist pg. 2) to list hazards and then rate the risk using the
Control Risk Rating Matrix. Detail control measures required to address the risks
Controls to be considered in the following order:
1. Elimination (is it necessary?) 5. Administration (training, SOP,)
2. Substitution 6. Personal Protective Equipment (PPE) (e.g. gloves,
3. Isolation (restrict access) leather apron, coveralls, respirator)
4. Engineering (guarding, redesign)
Risk assessment Risk Required Controls Controls
Identified Hazards Implemented
Exposure Consequences Likelihood Rating
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

Implementation Plan (for controls not already in place)

Control Selected Person(s) responsible Proposed Actual
completion completion

Person Completing Assessment

Name: Signature: Date:

Assessment Approval: (eg Principal researcher, Technical Director, Manager)

I am satisfied that the risks are adequately controlled.
Name: Signature: Date:
Position Title:
 Hazards: Potential to cause harm to people, property or the environment. Check the applicable hazards
Mechanical hazards Radiation Movement and controls

Accumulation of energy e.g. springs, Low-frequency, radio frequency radiation; Failure/lack of display or alarm system
liquids or gases under pressure, microwaves
vacuum
Crushing hazard Infrared, visible and UV radiation Restoration of energy supply after
Interruption
Cutting, shearing, friction or abrasion X-rays and gamma rays Errors or vulnerability in software or
hazard programming
Entanglement, drawing in or trapping Lasers Errors made by operator (human/machine
hazards mismatch)
Impact hazard Alpha and beta rays, electron beams Movement when starting engine
neutrons
Puncture/injection hazard Ergonomics/Human Factors Movement without all parts in a safe position

High pressure Unhealthy postures or excessive effort Insufficient ability to slow down, stop and
immobilize
Electrical hazards Inadequate consideration of hand-arm or From load falls, collisions, machine tipping
foot-leg anatomy (lack of stability)
Contact with live parts (direct contact) Inadequate lighting Uncontrolled loading-overloading-
overturning moments exceeded
Contact with parts which have become Inadequate design or identification of Unexpected/unintended movement of loads
live under faulty conditions (indirect manual controls or visual display
contact)
Approach to live parts under high Thermal hazards Hazards from coupling and towing
voltage (arc flash)
Electrostatic phenomena Burns, scalds by contact with objects or Vibration
materials (hot or cold)
Materials and substances Noise Hand-arm vibration
Contact/inhalation of harmful fluids, Hearing loss or other physiological Whole body vibration
gases, mists, fumes, dusts disorders
Fire and explosion Interference with speech, acoustic signals OTHER

Biological or microbiological hazards

RISK RATING MATRIX:

RISK SEVERITY/CONSEQUENCE
CRITICAL MAJOR MINOR NEGLIGIBLE
(severe injury or (injury resulting in at (medical aid (first aid
LIKELIHOOD fatality - >2 weeks least one day lost time, only, minor treatment, minimal
lost time, major moderate property property damage threat)
property damage) damage) )
VERY LIKELY
(likely to occur in a short period of time, expected High High Medium Medium
to occur frequently)
LIKELY
High Medium Medium Low
(quite likely to occur in time)
UNLIKELY
Medium Medium Low Very low
(not likely to occur, but possible)
VERY UNLIKELY
Medium Low Very low Very low
(Not likely to occur, even over time)

Risk priority Definitions of priority Time frame

Situation critical, stop work immediately or consider cessation of work process.
High Now
Must be fixed today, consider short term and/or long term actions.

Medium Is very important, must be fixed urgently, consider short term and/or long term actions. 1 – 3 weeks

Is still important but can be dealt with through scheduled maintenance or similar type
Low 1 - 3 Months
programming. However, if solution is quick and easy then fix it today.
Very low Review and/or manage by routine processes Not applicable

Safety Office
Equipment Risk Assessment_v.1.0_JUL2019 |2