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Life Safety Risk Assessment Form Template for New Zealand

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Key Requirements PROMPT example:

Life Safety Risk Assessment Form

"I need a Life Safety Risk Assessment Form for our new chemical manufacturing facility in Auckland, focusing particularly on hazardous substance handling and emergency response procedures, to be implemented by March 2025."

Document background
The Life Safety Risk Assessment Form is a critical document required under New Zealand's health and safety regulatory framework. It is designed to be used when organizations need to conduct thorough evaluations of potential risks to human life within their facilities or operations. The form addresses requirements set out in the Health and Safety at Work Act 2015 and associated regulations, providing a systematic method for identifying hazards, assessing their potential impact, and determining appropriate control measures. This document should be completed during initial facility setup, after significant changes to operations, during periodic safety reviews, or when specific safety concerns arise. It includes comprehensive sections covering hazard identification, risk evaluation, control measures, emergency procedures, and compliance requirements, making it an essential tool for maintaining workplace safety and meeting legal obligations in New Zealand.
Suggested Sections

1. Assessment Details: Basic information including date, location, assessor details, and scope of assessment

2. Site Information: Details of the property/facility being assessed, including address, building type, occupancy levels, and operating hours

3. Hazard Identification: Comprehensive list of potential life safety hazards identified during the assessment

4. Risk Assessment Matrix: Standard risk evaluation framework showing likelihood and consequence ratings

5. Risk Evaluation: Detailed analysis of each identified hazard using the risk matrix, including current control measures

6. Control Measures: Existing and recommended control measures to mitigate identified risks

7. Emergency Response: Assessment of emergency procedures, evacuation plans, and emergency equipment

8. Training and Competency: Evaluation of staff training needs and current competency levels related to life safety

9. Compliance Review: Assessment of compliance with relevant legislation and standards

10. Action Plan: Prioritized list of recommended actions with timeframes and responsibilities

Optional Sections

1. Specific Equipment Assessment: Detailed assessment of specific high-risk equipment or machinery, used when the site contains specialized equipment

2. Chemical Risk Assessment: Assessment of hazardous substances and dangerous goods, included when chemicals are present on site

3. Working at Heights: Specific assessment for locations with elevated work areas or fall risks

4. Confined Spaces: Detailed assessment of confined space risks, included when confined spaces are present

5. Historical Incident Review: Analysis of previous incidents and near-misses, included when historical data is available

Suggested Schedules

1. Floor Plans: Marked-up floor plans showing emergency exits, fire equipment, and high-risk areas

2. Photo Log: Photographic evidence of hazards and control measures identified during assessment

3. Risk Assessment Worksheets: Detailed worksheets showing calculations and methodology used in risk assessment

4. Equipment Register: List of safety-critical equipment and their maintenance schedules

5. Emergency Contact List: List of key personnel and emergency contacts

6. Compliance Certificates: Copies of relevant compliance certificates and inspection records

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈ˰æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions






























Clauses



















Relevant Industries

Manufacturing

Construction

Healthcare

Education

Retail

Hospitality

Warehousing and Logistics

Mining and Resources

Agriculture

Commercial Property

Industrial

Public Sector

Transportation

Relevant Teams

Health and Safety

Operations

Facilities Management

Risk Management

Compliance

Quality Assurance

Emergency Response

Workplace Services

Building Management

Environmental Health and Safety

Relevant Roles

Health and Safety Manager

Risk Assessment Specialist

Facility Manager

Operations Manager

Safety Consultant

Compliance Officer

Building Services Manager

Workplace Health and Safety Officer

Environmental Health and Safety Coordinator

Site Manager

Project Manager

Quality Assurance Manager

Emergency Response Coordinator

Occupational Health and Safety Specialist

Industries






Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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