Marine SWMS - Clayton's Towing Service

Marine Risk Assessment - Marine & Vessel

Please fill out the below form to submit the Marine Risk Assessment – Marine & Vessel.

MRA - M & V

Date *

Job Number: *

Customer Name:

ADDITIONAL HAZARDS/SPECIAL PRECAUTIONS/CONTROL MEASURES (to be completed where review may be necessary to determine) *

Yes

Hazard 1

Job Task Potential Hazard 1

Description of Hazard 1

Hazard 1 - Risk Likelihood

Hazard 1 - Risk Consequences

Hazard 1 - Risk Score

Hazard 1 - Control Measure (those provided and those required)

Hazard 1 - Control Measure Risk Likelihood

Hazard 1 - Control Measure Risk Consequences

Hazard 1 - Control Measure Risk Score

Hazard 1 - Responsible for verifying actions complete

Hazard 2

Job Task Potential Hazard 2

Description of Hazard 2

Hazard 2 - Risk Likelihood

Hazard 2 - Risk Consequences

Hazard 2 - Risk Score

Hazard 2 - Control Measure (those provided and those required)

Hazard 2 - Control Measure Risk Likelihood

Hazard 2 - Control Measure Risk Consequences

Hazard 2 - Control Measure Risk Score

Hazard 2 - Responsible for verifying actions complete

ACKNOWLEDGEMENT 1

Name 1 *

Signature 1 *

Clear

ACKNOWLEDGEMENT 2

Name 2

Signature 2

Clear

ACKNOWLEDGEMENT 3

Name 3

Signature 3

Clear

ACKNOWLEDGEMENT 4

Name 4

Signature 4

Clear

ACKNOWLEDGEMENT 5

Name 5

Signature 5

Clear

ACKNOWLEDGEMENT 6

Name 6

Signature 6

Clear

ACKNOWLEDGEMENT 7

Name 7

Signature 7

Clear

ACKNOWLEDGEMENT 8

Name 8

Signature 8

Clear

ACKNOWLEDGEMENT 9

Name 9

Signature 9

Clear

ACKNOWLEDGEMENT 10

Name 10

Signature 10

Clear

ACKNOWLEDGEMENT 11

Name 11

Signature 11

Clear

ACKNOWLEDGEMENT 12

Name 12

Signature 12

Clear