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RISK ASSESSMENT FORM

Permits Required
Job
Location:

Toilets

Yes/No

GUIDELINE FOR RISK RATING
Contact Nos:
1
...
Permit To work
2
...
Secrutity No- 0382400226

1

Very
Unlikely
Unlike
ly
Never
Heard
of in Heard of Incident in
Similar Industry
an
indust
ry

EMERGENCIES ONLY: 4: Toll Free No
...
Confined Space Entry

Production

Dept :

Supervisor's Name:

Harriet Mudal

Signature:

4
...
Excavation Permit
6
...


JOB STEPS

1 Cleaning/Mopping

2 Scrabbing/washing of the toilets

HAZARD
(Anything that has the
potential to cause harm)

HAZARD EFFECT
(What will be the effects to one or the environment)

SAFETY
HAZARDS
Slippery floor
Over bending

HEALTH HAZARDS
Causes falling
Back pain

faeces,
Water,
Scrabber

Too much smell
Water irritation,
Scrabber cuts

2

3

4

5

Likely

Very Likely

Almost Certain

Incident has
occurred in
Lafarge group

Happens several
times per year in
Lafarge group

Happens several times per year in BU

3
...


RISK
LEVEL
(H,M,L)
Prob
...
Elimination
2
...
Engineering (Scaffolds etc)
4
...
PPE

H/M/L

Injuries/Joint dislocation,
Spinal cord diseases

3

2

6

M

Use of safety boot,
Use long brush for scrabbing,
Use leather glooves

Stomach disorder,
Skin rashes,
Injuries

3

3

9

H

Use respirators,
Use of glooves

Residual Risk
(H,M,L)
Risk Rating = Severity x Probability

Prob
...


1

1

Scrabbers

2

2

Moopers

3

3

Toilet brush

4

4

Liquid Soap

5

5

JIK

6

6

Vim

7

7

Harpic

8

8

Urinal Balls

9

9

10

10

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