CaCH On Site Risk Assessment

• Site conducted

• Conducted on

  Date

• Prepared by

• Location
  Address

Overview

• Description of procedure, task or worksite being assessed

Risk Matrix and Hierarchy of Controls

• Hierarchy of Controls Reference:

Hazard Register

Hazard

• Description of hazard

• Photo of hazard

  Media

Risk Rating

• Consequences

  Select Fatality Major Injuries Minor Injuries Negligible Injuries Environmental Impact Impact to tenant/household Possible dangerous event

  • Fatality
  • Major Injuries
  • Minor Injuries
  • Negligible Injuries
  • Environmental Impact
  • Impact to tenant/household
  • Possible dangerous event

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk Rating (refer risk matrix above)

  High

  Medium

  Low

• Comments/ observations

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

  • Elimination
  • Substitution
  • Engineering Controls
  • Administrative Controls
  • PPE
  • Other

• Enter other

• Explanation of controls

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

  • Elimination
  • Substitution
  • Engineering Controls
  • Administrative Controls
  • PPE
  • Other

Completion

• Can works continue safely?

  Yes

  No

  N/A

• Recommendations

• Signature

  Sign