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Page 1: Risk assessment form

ACTIVITY HAZARDRISKH/M/L PRECAUTIONS

IN PLACE

REVIEW DATE REVIEWER

Dancing

Holding mugShaking rattle

Posing with the wedges

Moving map around

Banging head on fence.

Tripping. Hot drink – Hot mug.Hitting their self on the head.

Falling

Paper cut

L

MHM

H

H

Keeping my distance while dancing.Only head dance.Let the drink cool.Make sure the rattle keeps a distance.Make sure she keeps balance and the floor it flat and safe.Use a laminated map.

Yes

YesYesYes

Yes

Yes

Please leave this section blank:Risk Assessment checked by: Name ………………………………………………….. Signed …………………………………………………. Date ……………………

KEY: Activity : Describe the component part of your pursuit.Hazard : List the things you anticipate might cause harm or the things associated with your activity that have the potential to cause harm. Consider the likely

harm.Risk: Assess the risk as either H (High), M (Medium) or L (Low). When concluding your assessment consider all of the circumstances.Precautions: Consider what you could do to minimise / negate the risk.In Place: Will the precautionary measures be in place at the time of the activity?Review Date: When would it be reasonable to review your assessment? Remember it might be whilst you are undertaking the activity.Reviewer: Name of the person responsible for completing the risk assessment.

A copy of this form should be taken on the activity or visit by the Reviewer.V9/PALL/sspi/reviewedOct2010

V 9 RISK ASSESSMENT


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