Risk analysis – student

Student identification

Surname: First name:

Year of study2011-2012:
Date of birth:
NOMA (student card number):
National Register number:
Postal address:
Email address:
Telephone:

Nature of health assessment

o  As part of a work placement

Assessment of health prior to assignment:

For a young person in work or one on placement before their first posting

o  In other circumstances: give details (dissertation, advanced Master’s…)

To be completed by the person responsible for the student (supervisor, academic…)

Location of work
Name and address
Tel.:
Description of main tasks involved in the position:
Person responsible / Surname: / First name: / Telephone:
Existence of specific safety rules and/or procedures: / YES / NO
Driving
Vehicle and machinery driving in the workplace / Electric pallet truck
Lifting devices
Construction equipment
Overhead crane
Pillar jib
Forklift/stacking truck
Light van
Vehicle and machinery driving outside the workplace / Occasional trips
Delivery drivers
Trips abroad / Countries:
Taking research samples

Tick the work situations involved in the position

And sign on the last page

Fiche de poste- étudiant (mise à jour 08/09/11): 1/4

PREVENTION ET PROTECTION

Fire-Emergency / Organisational and psycho-social
Fire risk / Office-type work environment / Stress / Occasional stress
Kitchen work / High-stress situation
Work in storage area / Hazardous work
Use and storage of inflammable products / Emotional stress
Work with naked flames or producing sparks / Conflict management / Contact with the public
Special risk: Explosion / Personnel management
Emergency procedures / Occupation of office-type area / Security post
Occupation of hazardous area with special instructions / Night work
Occupation of storage area / Weekend work
Occupation of technical areas / Position demanding vigilance
Carrying weapons
Ergonomics
Restrictions in working position / Chemical risks
Risk of musculoskeletal problems (repetitive work) / Use of domestic products
Work at computer screen / Occasional use / Use of professional products
+ 4 h work at screen / Laboratory work
Continuous work / Specific risks / Reactive or unstable substances
Goods handling / Occasional or light handling work / Hazardous reactions
Heavy or repetitive handling work / Biological risks
Contact with plant connected to a hydraulic system
Hygiene / Contact with GMOs
Air quality / Dust / Contact with animals
Fumes / Contact with patients
Smoke / Contact with organic waste
Aerosol / Contact with organic liquids
Lack of 02 / Laboratory work
Contact with foodstuffs / Work in zones L2 or L3
Risks linked to ionising radiation / Physical risks
X-ray equipment / Occasional use / Thermal environment / Outside work
Frequent or continuous use / Work in a low-temperature environment
Maintenance and work on equipment / Work in a high-temperature environment
Particle accelerator, irradiators / Occasional use / Thermal risk / Work with high-temperature or very low temperature materials
Frequent or continuous use / Work with high-temperature or very low temperature equipment
Maintenance and work on equipment / Work on high-temperature or very low temperature equipment
Unsealed sources / ß -emitting radioisotopes (H3, C14, S35, p32) / Humidity
γ transmitters (I125, Tc99m,…) / Electromagnetic waves
β+ transmitters / Vibrations
Sealed sources / Occasional use / Noise / Occasional exposure
Frequent or continuous use / Work in a noisy environment
Maintenance and work on equipment / Ultrasound - infrasound
Maintenance of controlled areas / UV or IR rays
Work in controlled areas / Laser
Risks of falling / Falling objects / Electrical risks / Use of electrical material
People falling from height / Use of stepladders / Work on low-tension plant
Use of ladders / Work on high-tension plant
Use of scaffolding / Mechanical risks / Use of tools
Use of safety line, anchor / Use of machines
Use of lifting platform / Risks related to pressurised fluids / Use of plant
Work on roofs / Equipment maintenance
Slipping, tripping / Nanotechnology / Work with nanoparticles
Risk of collision / Collision with a vehicle
Collision with a machine / PERSON RESPONSIBLE IN WORK PLACE/DISSERTATION / Name: Date:
Signature:
Collision with plant

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