Safety Management Plan Template

Health, Safety and Wellbeing Handbook
HIGHER DEGREE BY RESEARCH : SAFETY MANAGEMENT PLAN

TO BE COMPLETED BY THE STUDENT & SUPERVISOR IN CONSULTATION
NOTE: ONLY THE FIRST PAGE MUST BE COMPLETED AND SUBMITTED TO THE ADELAIDE GRADUATE CENTRE
If further information related to the Hazard ID Form is required please consult with your local Health and Safety Officer or Manager, HSW
Student Name
Student Number
School
Contact details
Date
Supervisor
Room No
Mobile/Phone
HAZARD IDENTIFICATION FORM

(In discussion with your supervisor identify any foreseeable hazards associated with your project by ticking the appropriate boxes.
Hazards identified will need to be addressed on the Hazard Management Log - see page 2)
Physical/Environmental Hazards
Plant and Equipment
Noise > 85dB(A)
Temperature or weather extremes (e.g. heat, cold, wind, rain)
Radiation
Working on a slippery or uneven surfaces
Hit by flying, moving or falling object (including vehicles)
Fire hazard/naked flame other than controlled lab work
Biological
Remote areas/isolated locations

Confined space (e.g. pit, tank, silo, entry through a hatch)
Fall from a height (e.g. ladder, elevated platform, cliff)
Poor lighting/visibility
Vibrating objects or surface
First Aid/Evacuation
Additional first aid requirements due to the nature of the research

(e.g. field work or specific hazards)
A rescue effort would be difficult in the event of an emergency

(e.g. remote areas, difficult to access to work site)
Communications
Potential for communication problems (e.g. by virtue of location)

Research may disrupt/impact on adjacent areas of the University
Electrical
Electrical risk from portable electrical appliances or tools

Water and electricity in close proximity to each other
Ergonomics/Manual Handling
Working for long periods in a sustained awkward posture

Required to lift, push or pull heavy objects
Stress/Duress
Mobile plant will be introduced (e.g. forklift, mobile platform)

Scaffolding, raised platforms or ladders
Pressurised vessels/systems (e.g. autoclave, boiler)
Hazardous plant (e.g. lathes, lasers, microtomes, cryostats, etc)
Sealed sources
Unsealed sources
Other (e.g. UV)
Contamination (i.e. virus, bacteria, disease)
Human or animal body fluids/tissue
Animals (including fish, birds or insects that may introduce a

hazard e.g. handling, bite, sting, venom)
Needlestick\matrix bands
Surgical instruments
AQIS/OGTR
Chemical
Explosive substances
Flammable gas
Toxic or asphyxiant gas (e.g. CO2 including dry ice, liquid N2,)
Highly flammable liquid (Packing Group1)
Respiratory irritants (e.g. nanotech, asbestos, dust)
Chemical spraying (e.g. agricultural, pest )
Hazardous substances (not included above)
Personal security (e.g. physical harm by others)
Other
Stressful situations
________________________________________________
________________________________________________
Working alone\home visits

Working hours (e.g. long shifts required)
HSW Handbook
Authorised by
Warning
HDR Safety Management Plan Template

Effective Date:
11 February 2010
Vice Chancellor and President
Review Date:
February 2013
This process is uncontrolled when printed. The current version of this document is available on the HSW Website.
Version 1.1
Page 1 of 3
No hazards identified with this research
HSW Handbook
Authorised by
Warning
Students signature
__________________________
Supervisors signature
__________________________

Effective Date:
11 February 2010
Review Date:
February 2013
Version 1.1
Page 2 of 3
HAZARD MANAGEMENT LOG - To be completed by Student & Supervisor in consultation prior to commencement of the activity involving the specific hazard
Only the hazard identification process page 1 is required for completion of the core structure program, this section should be kept and maintained by the student and supervisor over the course of the
research project and reviewed at regular intervals. (The document should be kept in such a way that it can be found for safety audits as may be required from time to time).
Page No
Should you require additional pages please re-print this page and attach to the checklist.
Should you require any further information in relation to the risk assessments please discuss with your supervisor.
Date hazard
Identified
HSW Handbook
Authorised by
Warning
Description of the
Hazard.
When and/or where is the

hazard likely to occur?
(as identified on
page 1 or during
progress of the project)
(Activity or period when

you or others may be
exposed to this hazard)
Risk assessment ref.

(insert RMSS ref no
or attach a copy of the
assessment if a paper
version as a record)

Effective Date:
11 February 2010
Review Date:
February 2013
Date that the

assessment
completed or
reference noted
Version 1.1
Page 3 of 3
Signature of Student
Comments if activity has

not been risk assessed
or if activity has been
removed from the project
Supervisors
initials

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What is the purpose of the safety management plan?

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What hazards are identified in the plan?

What hazards are identified in the plan?

Health, Safety and Wellbeing Handbook

HIGHER DEGREE BY RESEARCH : SAFETY MANAGEMENT PLAN

HAZARD IDENTIFICATION FORM

Plant and Equipment

Noise > 85dB(A)

Temperature or weather extremes (e.g. heat, cold, wind, rain)

Working on a slippery or uneven surfaces

Hit by flying, moving or falling object (including vehicles)

Fire hazard/naked flame other than controlled lab work

Remote areas/isolated locations

Vibrating objects or surface

Additional first aid requirements due to the nature of the research

A rescue effort would be difficult in the event of an emergency

Potential for communication problems (e.g. by virtue of location)

Electrical risk from portable electrical appliances or tools

Working for long periods in a sustained awkward posture

Mobile plant will be introduced (e.g. forklift, mobile platform)

Contamination (i.e. virus, bacteria, disease)

Human or animal body fluids/tissue

Animals (including fish, birds or insects that may introduce a

Personal security (e.g. physical harm by others)

Working alone\home visits

HDR Safety Management Plan Template

No hazards identified with this research

HDR Safety Management Plan Template

When and/or where is the

(Activity or period when

Risk assessment ref.

HDR Safety Management Plan Template

Date that the

Comments if activity has

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