Downer EDI Rail

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Plant Description (Incl. Tool No.)

• Process Assessed:

• Assessor(s);

• Signature

  Sign

• Position

HAZARD IDENTIFICATION (Answering YES to any of the following will require it to be entered into the Risk Control Schedule

• 1.1- Is the plant unsuitable for its actual or intended purpose?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.2- Will environmental conditions or terrain cause a hazard?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.3- ENTANGLEMENT<br>Can hair, clothing, gloves, necktie, jewellery, cleaning brushes, rags or other materials become entangled with moving parts of the plant or material in motion?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

CRUSHING OR TRAPPING Can anyone be crushed or trapped due to:

• 1.4- Material falling off plant

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.5- Uncontrolled movement of plant or its load

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.6- Coming into contact with moving parts

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.7- Tipping or rolling over of plant

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.8- Being thrown off or under plant

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.9- Parts of plant collapsing

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.10- Being trapped between plant, materials/fixed structures

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.11- Other factors

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

CUTTING, STABBING, PUNCTURING, STRETCHING, STRIKING. Can any of the above occur due to:

• 1.12- Coming into contact with sharp of flying objects

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.13- Coming into contact with moving parts

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.14- Plant or parts of the plant or work pieces disintegrating, or being expelled

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.15- Mobility or uncontrolled movement of the plant or its load

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.16- Other factors

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.17- SHEARING<br>Can body parts be sheared between 2 parts of plant, or between a part of a plant and a work piece or structure?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.18- FRICTION<br>Can anyone be burnt or suffer abrasion due to contact with moving parts or surfaces, material handled by the plant?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.19- HIGH PRESSURE FLUID<br>Can anyone come into contact with fluids under high pressure, including during plant failure or misuse of the plant?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.20- FIRE and/or EXPLOSION<br>Can there be a fire; or an explosion of gases, vapours, liquids, dust or other substances triggered by the operation of the plant, or materials to be handled?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

ELECTRICAL Can anyone be injured by electrical shock or burnt due to:

• 1.21- Overload of electrical circuits

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.22- Damaged or poorly maintained electrical leads, cables or switches

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.23- Water/liquid near electrical equipment

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.24- Lack of isolation procedures

  Yes

  No

  N/A

• 1.25- Other factors

  Yes

  No

  N/A

SLIPPING, TRIPPING, or FALLING Can any of the above occur due to:

• 1.26- Uneven, slippery or poor work or walking surfaces on or around the plant

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.27- Platforms without handrails, guardrails, or other suitable edge protection (eg. kickboards)

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.28- Lack of proper platform, stairs or ladders

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.29- Unprotected holes

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.30- Lack of fall protection provided were working above 2m

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.31- Collapse of the supporting structure

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.32- Other factors

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

ERGONOMIC Can anyone be injured due to:

• 1.33- Poorly designed seating

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.34- Repetitive body movement

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.35- Awkward body posture or the need for excessive effort

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.36- Design deficiency causing mental or psychological stress

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.37- Inadequate lighting for plant operation, maintenance and/or cleaning

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.38- Room for human error

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.39- Operator controls are located for ease of use in a logical arrangment

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.40- Operator controls are identified and clearly marked / labelled

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.41-Manual handling associated with the use of the plant

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.42- Other factors

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

SUFFOCATION Can anyone be suffocated or engulfed due to lack of oxygen, atmospheric contaminants such as;

• 1.43- Vapour

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.44- Dust

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.45- Moisture

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.46- Gases

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.47- Other

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

OTHER Can anyone be injured or suffer ill health from exposure:

• 1.48- Radiation

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.49- Vibration

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.50- Cold

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.51- Laser beams

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.52- Chemicals

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.53 Noise

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 1.54- Other

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

Answering No to any of the following will require it to be entered into the Risk Control Schedule

• 2.1- Has Personal Protective Equipment (PPE) been identified & provided for safe operation of this plant?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.2- Is there adequate signage in place to indicate specific hazards and PPE requirements?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.3- Are there established authorised permit systems for the plant and/or surrounds?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.4- Have Risk Assessment, Instructions or Manuals been provided and reviewed for specific commissioning, operation, maintenance and special precaution details?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.5- Are the current guards(s) and their condition adequate for this plant?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.6- Are interlocks present and operational on this plant?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.7- Are Emergency Stops coloured RED, clearly marked and are of "mushroom type"?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.8- Are Emergency stops located at the most likely place(s) and within easy reach for an emergency an emergency?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.9- Is there a provision to lock out the plant, and dissipate energy?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.10- Are CWI's or instructions for plant displayed on or near plant?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.11- Have operators been trained and signed off on CWI's or operating instructions?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.12- Can access to moving parts from a platform be performed

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.13- Does access to platforms/ladders/handrails provide secure, non-slip access at any time?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.14- Are there provisions for safe cleaning, servicing and routinely grease and oiling this plant?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.15- Is there safe access provided to be cleaned?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.16- Is there provision for easy and safe scrap material?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.17- Does the plant have the potential to jam/block?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.18- Is there a CWI or instruction to safely remove jam/blockage and is this displayed at plant site?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• 2.19 Ventilation and/or other flow needs are adequate?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Have hazardous substances associated with the plant been assessed and an MSDS displayed at/near plant site?

  Yes

  No

  N/A

• DESCRIPTION OF HAZARD

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic

• Controls Required?

• Controls in place

  Yes

  No

  N/A

• Person responsible for implementing controls?

• Transferred to HSE Action Plan?

  Yes

  No

  N/A

• Date Completed?

  Date

• RESIDUAL RISK RATING

• Risk rating- Likelihood

  Rare

  Unlikely

  Possible

  Likely

  Almost Certain

• Risk rating- Consequences

  Select Insignificant Minor Moderate Significant Major Catastrophic

  • Insignificant
  • Minor
  • Moderate
  • Significant
  • Major
  • Catastrophic