SEGMENT 1 – HEALTH AND SAFETY AT WORK 
SAQ  Unsafe Acts – something you do or don’t do
Leaving equipment in an unsafe condition	For example, noticing a cracked waterproof power socket cover and being too busy to report it, thinking I’ll do it at the end of the shift.	
Removing safety devices such as guards		
Using equipment for something it wasn’t designed to do		
Failing to wear personal protective equipment		
Lifting loads incorrectly		
Unauthorised servicing or modification of equipment		
Working under the influence of alcohol or drugs		
Using defective or malfunctioning equipment		
From your own experiences, try and identify an example of the various factors that can contribute to human failure, and give an example of an error and a violation.

  An example of a possible Environmental Factor at work could be?
	
An example of a possible Occupational Factor at work could be?
	
An example of a possible Error could be?	
	
A possible Violation could be?

SEGMENT 3 – ACCIDENTS AND ILLNESS 
SAQ  Please list four examples of possibly unsafe activities and four unsafe conditions that could occur in your workplace.
Possible Unsafe Activities	

	

Possible Unsafe Conditions	

	

SEGMENT 4 – RISK ASSESSMENT 
In the space below list five hazards each for the workplace, equipment and people.

Workplace	Equipment	People	

			

SEGMENT 7 – WORKPLACE SAFETY 
  The types of maintenance and housekeeping activities will vary from job to job.  Please list the ones that are carried out in your workplace.
Housekeeping Activities
•	
•	
•	
•		Maintenance Activities
•	
•	
•	
•	 

SAQ  Please list them in the table below; simply write in what the sign covers and how many of that type you have found.  I’ve given you a few to start with.
Prohibition	Warning	Mandatory	Escape etc	Fire	

Smoking (    )

	
Electricity (    )	
Ear defender (   )	
First Aid  (    )	
Fire alarm (    )	

Against each type of non-mechanical hazard I would like you to write an example of your own, ideally one from your own workplace.
Hazard	Your Own Example	
Electricity		
High temperatures		
Vibration		
Noise		
Chemicals		
Radiation		
Low temperatures		

SEGMENT 8 – WORK EQUIPMENT 
  Please list the common forms of PPE worn in your workplace.  Against each form of PPE list the hazards they protect against.
PPE	Hazards	

		

SAQ
List the three factors that form the triangle of combustion. 
1.
2.
3.

SEGMENT 10 – FIRE PREVENTION 

Carbon dioxide extinguishers are mainly for use on fires involving electrical equipment. List some of the problems of using carbon dioxide extinguishers.
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The above self assessment questions were completed by:

Name:			 _________________________
Signature:		 _________________________
Date Completed:	 _____________