RAMS Form (Risk Analysis Management System)

Fill this in on your phone. Tap the boxes and type in the blanks. What you enter is kept on this phone while you work. When you are done, send it to the safety team, or print it.

Appendix 9 – Rams Form

[ Church name ] church

Risk assessment method statement (RAMS)

Figure -Online Form

Instructions: Complete this form for specific activities or projects that involve significant risks. This form combines risk assessment with safe work method statements.

Project/activity details

Field Information
Activity/Project:
Location:
Date(s): From: To:
Prepared By:
Date Prepared:
Approved By:
Date Approved:

Scope of work

Detailed Description of Activity:

Personnel Involved:

Name Role Qualifications/Training Contact

Equipment/Tools Required:

Materials/Substances Used:

Risk assessment

Hazard Who at Risk Potential Harm Likelihood (1-5) Consequence (1-5) Risk Rating Control Measures

Risk Rating Scale: - 1-4: Low Risk - Acceptable with monitoring

  • 5-9: Medium Risk - Additional controls required - 10-16: High Risk - Immediate controls required - 17-25: Extreme Risk - Stop work until controls implemented

Control measures

Personal Protective Equipment (PPE) Required:

Person Hard Hat Safety Glasses Gloves Hi-Vis Safety Boots Other

Safety Equipment/Systems:

Environmental Controls:

Safe work method statement

Step-by-Step Procedure:

Step Task Description Hazards Control Measures Responsible Person
1
2
3
4
5
6
7
8

Emergency procedures

Emergency Contacts:

Service Number
Emergency Services 111
Church Emergency Contact
Project Supervisor
First Aid Officer

Emergency Equipment Location:

Equipment Location
First Aid Kit
Fire Extinguisher
Emergency Shower/Eyewash
Spill Kit

Emergency Procedures:

Injury/Medical Emergency:

  1.  
  2.  

Fire Emergency:

Chemical Spill:

  2.  

Environmental considerations

Weather Conditions:

Noise Considerations:

Dust/Emissions Control:

Waste Management:

Permits and approvals

Required Permits/Approvals:

Permit/Approval Required Obtained Valid Until
Building Consent
Resource Consent
Electrical Work Permit
Hot Work Permit
Confined Space Entry
Working at Height Permit

Communication plan

Pre-Work Briefing: Date/Time:

Daily Briefings: Time:

Congregation Notification: Method:

Contractor Coordination: Contact:

Monitoring and review

Supervision Arrangements:

Inspection Schedule:

Inspection Type Frequency Responsible Person
Daily safety check Daily
Equipment inspection
Environmental monitoring

Review Triggers:

Training and competency

Training Requirements:

Person Training Required Completed Valid Until

Induction Requirements:

Sign-off

Risk Assessment Completed By:

Name:

Signature: Date:

Position:

Method Statement Reviewed By:

Name:

Signature: Date:

Position: Health & Safety Champion

Work Approved By:

Name:

Signature: Date:

Position: Senior Pastor / Project Manager

Worker acknowledgment

I have read and understood this RAMS and agree to follow the procedures outlined:

Name Signature Date

Completion record

Work Commenced: Time:

Work Completed: Time:

Any Incidents/Issues:

Lessons Learned:

Completed By: Date:

Finished?

All policies