Environmental Risk Assessment

• Site name

• Conducted on

  Date

• Prepared by

• Location
  Address

Odour

• Odour

  Safe

  At Risk

  N/A

Hazard

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Severity

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Enter other control measures

• Description of control measures and risk management

Noise and Vibrations

• Noise and Vibrations

  Safe

  At Risk

  N/A

Hazard

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Severity

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Enter other control measures

• Description of control measures and risk management

Emissions

• Emissions (including dust, mud, litter and pests)

  Safe

  At Risk

  N/A

Hazard

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Severity

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Enter other control measures

• Description of control measures and risk management

Structural ground

• Ground (unstable environment, trenching etc.)

  Safe

  At Risk

  N/A

Hazard

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Severity

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Enter other control measures

• Description of control measures and risk management

References

• Risk Matrix Reference

  

Completion

• Recommendations

• Assessor's Name and Signature

  Sign