Track the implementation of control measures for workplace hazards with our Implementation Monitoring form. Ensure safety and compliance in your workplace.
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Implementation Monitoring (Complete one form per workplace area or group if required) Ref No Hazard Description Implemented Control Implementation Outcome Brief Description of Hazard Area after Next Inspection Date of Inspection Signature of Supervisor/Relevan t Personnel 1 The entrance gateofthe kitchenis blocked by a Large trolley rack Removingthe trolleyfromthe passageand placingitina suitableadsafe position. Workershave placed the object is a proper place The trolley has been placed in a middle of the kitchen room which was again a hazardous issue 22/5/2019 2 Displaced floormade thefloor unevenand riskyfor walking The gap between two carpet should befilledbyany softmaterialor hazardsignis needed Workershave foundallthe floorgapsand will fill them with soft materials Workers have filled only that particular place, however there are other places which were not received appropriate attention 15/6/2019 3 Emergency Exitfoodis blocked by a dangerously placed metallic Removing the metallic objet from the front of theemergency gateandplacing theobjectina safe and secured Workershave removedthe metallic object in frontofthe emergency gate Workers have placed the object in the store room and the place is not secured properly 18/6/2019
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equipmentplace. 4 A large trayis placedover thetopofa furniture dangerously besidethe boardroom Removingthe tray from the top ofthefurniture andplacingitin aflatgroundto avoid accident Workershave madesurethat no other material is hanging out The tray was placed properly that has zero potentiality to cause hazards 14/6/2019 5 The unassembled furniture are placedin scattered way Thescattered furnitureshould beproperly assembledand placed safely. Theworkers haveassembled thefurnitureto makethe premise secure The sharp ages were still directed to the outside making potential cause of hazard. 10/6/2019 6 Gapin ceilinglayer ismaking theceiling platelose and dangerous Theceilingplate should be placed properlysothat itcouldnotfall offandcause physical harm Workershave restoretheplate properly Workers have placed only that particular plate, however there are other plates which were not received appropriate attention 12/6/2019 7 Electrical wiresare scattered Theelectricalwires shouldbeconcealed throughusingfibre A electricianwill beappointedto makeacovered up wiring system The electrical wires have not received proper care and service 15/6/2019
overthe floor dangerously plating 8 The signboardis placed bellowthe safe height Removingthe signboardfrom itspositionand puttingthe signboardata safe height Theworkers havefitthe signboardto makethe premise secure The sign board is hanging in risky position that can cause hazard 14/6/2019 9 Abroken dooris placedon the wall Removing the door from the current place and placing the object in a safe and secured place. Theworkers haveremoved thefurnitureto makethe premise secure The door was placed correctly, however, more secured positioning will be required 18/6/2019 10 Ametal ladderis placedin front of store room entrance Removing the metal ladder from the current place and placing the object in a safe and secured place. Theworkers havereplaced themetalladder tomakethe premise secure It was not placed at the designated secured place that is making potential cause of hazard. 21/6/2009
FOR THE ASSESSOR: Checklist – Does the implementation plan meet the following requirements? Y/N 1.ALL hazards from the hazard inspection form must be included. Y 2.A specific action relating back to the risk assessment matrix must be listed for each hazard. Y 3.At least two persons must be listed as being responsible for each action item. Y 4.A specific completion date must be included for each hazard if using the workplace pathway. Y 5.A realistic monitoring plan must be provided for each hazard to ensure it does not revert to the level of risk prior to the controls being implemented. Y 6.At least five control plans were implemented and documented in the Implementation Log. Y 7.At least two persons other than the student have participated in implementing the control plan (will be checked with the video submitted). Y Checklist – Does the implementation monitoring sheet meet the following requirements? Y/N 8.A brief description of the hazard area identified after the control was implemented Y 9.A date when the new inspection was conductedY 10.Signature of supervisor/relevant personnel to ensure that the inspection was conducted Note: Applicable only to Workplace Pathway as Simulated Pathway will be signed off by the Assessor. Y