ACGC Risk Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date and Time Form Completed

  Date

• Form Completed By

  Sign

• Photo Of Risk

  Media

• Reference Number

Hazard Identification

• Hazard

• Associated Risk

• Specific circumstances relating to the risk

• Persons at risk

Risk Assessment

• Existing control measures ( if any )

• Likelihood:

  Almost certain

  Likely

  Possible

  Unlikely

  Rare

• Consequences

  Catastrophic

  Major

  Moderate

  Minor

  Insignificant

Risk Control

• Possible control options

• Elimination

• Substitution, Isolation or Engineering:

• Administrative or personal protective equipment

• Preferred control options ( and why )

Implementation Plan

Review

• Are the control measures in place ?

  Yes

  No

  N/A

• Are the controls preventing or minimising the risk ?

  Yes

  No

  N/A

• Are there any new problems with the risk ?

  Yes

  No

  N/A