Form

Management of health and safety in defence: safety forms (JSP 375)

Health and safety forms relating to the leaflets published in Joint Service Publication (JSP) 375.

From:
Ministry of Defence
Published
21 May 2009
Last updated
1 November 2024 — See all updates

Documents

MOD Form 960: asbestos personal record annotation

PDF, 866 KB, 1 page

MOD Form 1003: display screen equipment (DSE) authorisation for reimbursement of DSE eyesight test and provision of spectacles

ODT, 27.3 KB

This file is in an OpenDocument format

MOD form 5010: MOD risk assessment form

Ref: MOD form 5010

PDF, 646 KB, 2 pages

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MOD form 5010: MOD risk assessment form

ODT, 43.7 KB

This file is in an OpenDocument format

MOD form 5010A: dynamic risk assessment

PDF, 560 KB, 1 page

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MOD form 5010A: dynamic risk assessment

ODT, 11.1 KB

This file is in an OpenDocument format

MOD risk assessment MF5010 and MF5010A: guidance notes

PDF, 115 KB, 5 pages

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MOD risk assessment MF5010 and MF5010A: guidance notes

ODT, 32.8 KB

This file is in an OpenDocument format

MOD form 5011: COSHH assessment form

ODT, 108 KB

This file is in an OpenDocument format

MOD form 5011a: COSHH master register

ODT, 31.8 KB

This file is in an OpenDocument format

MOD Form 5011b: routine COSHH exposure monitoring record (introduced May 2014, replaces MOD Form 933E)

ODT, 30.2 KB

This file is in an OpenDocument format

MOD form 5012: manual handling assessment

ODT, 110 KB

This file is in an OpenDocument format

MOD form 5013: display screen equipment generic workstation risk assessment

PDF, 810 KB, 5 pages

MOD Form 5014: DSEAR risk assessment

ODT, 34.9 KB

This file is in an OpenDocument format

MOD form 5016: display screen equipment user risk assessment

PDF, 760 KB, 3 pages

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MOD form 5016: display screen equipment user risk assessment

ODT, 31.5 KB

This file is in an OpenDocument format

MOD form 5017: noise assessment record

ODT, 58.6 KB

This file is in an OpenDocument format

MOD Form 5030: PPE serviceability inspection/audit

ODT, 10.6 KB

This file is in an OpenDocument format

MOD Form 5031: PPE user inspection instruction

ODT, 10.8 KB

This file is in an OpenDocument format

MOD Form 5032: respiratory protective equipment self-assessment health surveillance

PDF, 702 KB, 2 pages

MOD Form 5033: respiratory protective equipment qualitative fit test form

PDF, 1.48 MB, 6 pages

MOD form 5050: excavation statement known hazards

ODT, 148 KB

This file is in an OpenDocument format

MOD form 5051: personal health record (Health Surveillance (HS) or Health Monitoring (HM))

PDF, 632 KB, 5 pages

MOD Form 5053 - Self-Assessment (Health Surveillance (HS) or Health Monitoring (HM))

PDF, 598 KB, 2 pages

MOD Form 5053 - annex A

PDF, 912 KB, 5 pages

MOD Form 5053 - annex B

PDF, 810 KB, 4 pages

MOD Form 5053 - annex C

PDF, 674 KB, 3 pages

MOD form 5070: permit to dig

ODT, 18.9 KB

This file is in an OpenDocument format

MOD form 5071: permit to work

ODT, 24.4 KB

This file is in an OpenDocument format

MOD form 5072: register of permits to work

ODT, 11.8 KB

This file is in an OpenDocument format

First aid notice template

ODT, 79.8 KB

This file is in an OpenDocument format

Workplace inspection template

ODT, 17.8 KB

This file is in an OpenDocument format

Details

The Ministry of Defence (MOD) health and safety forms are referenced in MOD Joint Service Publication (JSP 375) Management of health and safety in defence and are used by MOD staff to undertake assessment of the risks/hazards of their activites to ensure that their health and safety and the health safety of colleagues are not put at risk.

Updates to this page

Published 21 May 2009
Last updated 1 November 2024 + show all updates

  1. Updated 'MOD form 5013: display screen equipment generic workstation risk assessment'.

  2. Updated: MOD Form 960 and MOD Form 5032. Added: MOD Form 5033.

  3. Updated 'MOD form 5013: display screen equipment generic workstation risk assessment' and 'MOD form 5016: display screen equipment user risk assessment'.

  4. Updated 'MOD form 5051: personal health record (Health Surveillance (HS) or Health Monitoring (HM))', added 'MOD Form 5053 - Self-Assessment (Health Surveillance (HS) or Health Monitoring (HM))' and annexes A-C. Removed 'MOD Form 5054: Hand arm Vibration (HAV) annual health surveillance self assessment' as this has been incorporated into MOD Form 5053.

  5. Updated 'MOD form 5010: MOD risk assessment form' and added 'MOD form 5010A: dynamic risk assessment' and 'MOD Risk Assessment MF50101 and MF5010A: guidance notes'.

  6. Replaced form 5016.

  7. Updated: MOD form 5051 personal exposure record form.

  8. Updated all JSP 375 forms updated to open document text versions.

  9. Added revised MOD form 5011 (revised August 2017), MOD form 5011b: routine COSHH exposure monitoring record (replaces MOD form 993E), and MOD form 5016.

  10. Updated MOD Form 5010 to version 1.3.

  11. Added revised MOD form 5011a: COSHH master register.

  12. Added revised MOD Form 5014.

  13. Added updated MOD 5056 form.

  14. Added updated DSE MOD form 1003.

  15. Updated current and added new forms.

  16. Added updated version of MOD Form 5011.

  17. Published revised MOD form 5014: DSEAR risk assessment

  18. Updated summary and detail sections.

  19. Replaced MOD form 5014: DSEAR risk assessment to latest version

  20. First published.

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