Title Page
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Conducted on
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Enter site name, address
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Prepared by
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STOP and SURVEY your surroundings and identify the hazards. ASSESS what could go wrong and put CONTROL measures in place to minimise risk. Do NOT start if you think it is unsafe to do so - notify senior personnel if unsure. STOP, THINK and REASSESS if conditions change only continue when safe to do so.
General
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Enter description of procedure, task, incident or worksite being assessed
Hazards, Risks and Controls
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Click Add Hazard (+) after you have observed and identified a task and associated hazard
Hazard
Hazard
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Identified Hazard's
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Provide details
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Photo of hazard (optional)
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Persons at risk
Initial risk rating
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Initial consequence
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Initial likelihood
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Initial risk rating
Controls
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Select control measures
- Elimination
- Substitution
- Engineering Controls
- Administrative Controls
- PPE
- Other
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Enter other control measures
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Enter description of control measures
Residual risk rating
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Residual consequence
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Residual likelihood
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Residual risk rating
References
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Risk Matrix Reference
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Hierarchy of Controls Reference
Completion
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Useful information
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Signature