Hand Arm Vibration Plant Use Record
Operative Name:
Week Commencing Date:
Operative Signature:
Company Signature:
Print Name:
Review of Exposure Levels
To be completed by A M Water Services office:
1. Has the operative attained 100 exposure points on any given day? (delete as required)
If 'No' then no further action is required.
2. Has the operative attained 400 exposure points on any given day? (delete as required)
If you have answered 'Yes' to either of the previous questions then it is necessary to consider suitable measures to reduce the level of exposure to vibration.
* Look for alternative work methods which eliminate or reduce exposure to vibration. In short, could the work be done any other way? (delete as required)
* Could we mechanise or automate the work? (delete as required)
* Was the correct equipment used for the job?
If answering 'No'; why was this not possible -detail below: (delete as required)
* Was the equipment used, that which offers the lowest levels of vibration for the group tools? (delete as required)
* Have you given the operative any specific instructions following the review of the record?
If 'Yes'; please detail those instructions below: (delete as required)
Company Signature:
Print Name:
Date of review:
Important Note:
If you answered 'YES' to questions 1 & 2 this form must also be given to senior management.
** Please ensure this record is kept for future reference **