Lifting Risk Assessment Form
Evaluate lifting-related workplace risks by assessing the task, load, environment, and controls.
Assessor Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Describe the lifting task
*
How often is this lifting task performed?
*
Please Select
Occasionally
Daily
Several times a day
Weekly
Other
Approximate weight of the load (kg)
*
Describe the shape and stability of the load
*
Are there environmental hazards present?
Slippery floors
Obstructed pathways
Poor lighting
Temperature extremes
None
Other
What controls or safety measures are in place?
*
Are mechanical aids used?
*
Yes
No
Additional comments or recommendations
Submit Assessment
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