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Risk Assessment Form: Department of Mechanical Engineering

This risk assessment form requires information about a project activity including: - A description of the activity and location it will take place - Names of those involved and potential risks/consequences - Use of hazardous materials, mains electricity, or pressurized equipment - Required precautions, personal protective equipment, shutdown procedures, and emergency responses The student and supervisor must declare awareness of risks and approval for the activity. The area safety warden determines supervision levels and approves the activity to proceed.

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Amy Leigh Williams
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295 views

Risk Assessment Form: Department of Mechanical Engineering

This risk assessment form requires information about a project activity including: - A description of the activity and location it will take place - Names of those involved and potential risks/consequences - Use of hazardous materials, mains electricity, or pressurized equipment - Required precautions, personal protective equipment, shutdown procedures, and emergency responses The student and supervisor must declare awareness of risks and approval for the activity. The area safety warden determines supervision levels and approves the activity to proceed.

Uploaded by

Amy Leigh Williams
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Department of Mechanical Engineering

Risk Assessment Form

Risk Assessments are not required for simple workshop activities covered by the Safety Declaration.
However permission must be obtained from Mr Glen Newins before commencing any activity in the
Workshop.
A new Risk Assessment form needs to be completed for each major activity within your project.
You are required to include this document (signed) in your bound project submission and mount a
copy next to any rig / apparatus you are using.

Your Name
Your Supervisor
Project title and
number
Area Safety Warden
This Section to be completed by the student (Must be typed and the declaration signed)
Location where the activity will be
done
Describe the activity
(use attachment with diagrams if
needed)
Names of persons involved in this
activity
Describe in detail the risks you (and
others) will face during this activity
and the potential consequences of
your activities
Does your project involve the use of
any materials (chemicals, gasses,
etc.) which may be hazardous to
health, or the environment
Does this activity involve any
equipment / device designed or built
by you which is to be plugged into
mains electricity?
Does your project involve any new
equipment / devices designed which
contain gas or volatile liquids at
pressure?
What precautions are required to
protect against the risks detailed
above?
Describe the personal protective
equipment (PPE) required during this
activity specify in detail.
Describe the shutdown procedure in
detail.

N
o

Ye
s

If Yes list the chemicals / gasses to be used and attach the MSDS(s)
for these materials.

N
o

Ye
s

If Yes please consult with Mr Julian Mayer before connecting to the


mains / switching on.

N
o

Ye
s

If Yes please check the relevant SANS Pressurised Equipment


Regulations and consult with Dr Fuls before design, build or test.

Describe any relevant emergency


procedures, e.g. spillage response
etc.
I declare that I am aware of the risks
associated with this activity and will
take all necessary steps to mitigate
these risks.

Student Signature

Date

I am aware of the students intended


activity, and have provided the
necessary guidance, inputs, and
oversight.

Supervisor Signature

Date

This section to be completed by the Area Safety Warden


Level of supervision required
A = work may not take place without supervisor/warden
(Please tick relevant block)
present.
B = work may not take place without a 2nd party present.
C = no specific extra supervision requirements.

I am satisfied that the student is


aware of the risks associated with
this activity and grant approval for
it to proceed.

Signature

Date

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