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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.

Updates to this page

From:
Ministry of Defence
Published:
21 May 2009
Last updated:
6 March 2026
Show all updates

  1. Updated MOD Form 5011, added MOD Form 5011 Extension and MOD Form 5011 Guidance Notes.

  2. MOD Form 5017: Noise assessment record updated and added PDF version.

  3. MOD Forms 5020, 5040 and 5041 added following inclusion with Chapters 4 & 43

  4. MOD Form 5010, 5010a and their guidance notes updated.

  5. Updated 'MOD form 5012: manual handling assessment'. Added 'MOD form 5012A: manual handling Risk Assessment – Push / Pull (RAPP) form'.

  6. Added 'MOD form 5001: individual assessment and stress reduction tool'.

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

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

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

  10. 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.

  11. 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'.

  12. Replaced form 5016.

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

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

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

  16. Updated MOD Form 5010 to version 1.3.

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

  18. Added revised MOD Form 5014.

  19. Added updated MOD 5056 form.

  20. Added updated DSE MOD form 1003.

  21. Updated current and added new forms.

  22. Added updated version of MOD Form 5011.

  23. Published revised MOD form 5014: DSEAR risk assessment

  24. Updated summary and detail sections.

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

  26. First published.

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 5001: individual assessment and stress reduction tool

PDF, 830 KB, 9 pages

This file may not be suitable for users of assistive technology.

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MOD form 5001: individual assessment and stress reduction tool

ODT, 36.5 KB

This file is in an OpenDocument format

MOD form 5010: MOD risk assessment form

Ref: MOD form 5010

PDF, 604 KB, 2 pages

This file may not be suitable for users of assistive technology.

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MOD form 5010: MOD risk assessment form

ODT, 26 KB

This file is in an OpenDocument format

MOD form 5010A: dynamic risk assessment

PDF, 559 KB, 1 page

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MOD form 5010A: dynamic risk assessment

ODT, 12 KB

This file is in an OpenDocument format

MOD risk assessment MF5010 and MF5010A: guidance notes

PDF, 189 KB, 6 pages

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MOD risk assessment MF5010 and MF5010A: guidance notes

ODT, 31.2 KB

This file is in an OpenDocument format

MOD form 5011: COSHH assessment form

PDF, 865 KB, 2 pages

MOD form 5011: COSHH assessment form

ODT, 52.3 KB

This file is in an OpenDocument format

MOD form 5011: COSHH assessment form extension

PDF, 737 KB, 2 pages

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MOD form 5011: COSHH assessment form extension

ODT, 14.3 KB

This file is in an OpenDocument format

MOD form 5011 - guidance notes

PDF, 214 KB, 4 pages

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

PDF, 1.14 MB, 7 pages

MOD form 5012A: manual handling Risk Assessment – Push / Pull (RAPP) form

PDF, 876 KB, 7 pages

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, 697 KB, 3 pages

MOD form 5016: display screen equipment user risk assessment

ODT, 48.1 KB

This file is in an OpenDocument format

MOD Form 5017 - Noise assessment record

PDF, 828 KB, 7 pages

MOD Form 5017 - Noise assessment record

ODT, 68.8 KB

This file is in an OpenDocument format

MOD Form 5020 - workplace inspection checklist / report (ODT)

ODT, 73.3 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 5040 - EIH tier 1 assessment record (PDF)

PDF, 619 KB, 1 page

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MOD Form 5040 - EIH tier 1 assessment record (ODT)

ODT, 12.6 KB

This file is in an OpenDocument format

MOD Form 5041 - EIH tier 2 assessment record (PDF)

PDF, 727 KB, 6 pages

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MOD Form 5041 - EIH tier 2 assessment record (ODT)

ODT, 27.4 KB

This file is in an OpenDocument format

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

PDF, 878 KB, 7 pages

MOD form 5071: permit to work

ODT, 43.3 KB

This file is in an OpenDocument format

MOD form 5072: register of permits to work

PDF, 728 KB, 1 page

MOD form 5072: register of permits to work

ODT, 21 KB

This file is in an OpenDocument format

First aid notice template

ODT, 79.8 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.

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