Title Page

  • At Maxima Training Group (Aust) Ltd, our job is to make sure the workplaces where we place our workers are safe prior to placement and they remain safe during the assignment. To achieve this, in consultation with you, the host employer, we are required to evaluate your systematic approach to managing workplace Health and Safety, which in turn allows us to make the safest decision about the supply of workers. This form is designed to give us an overview of your safety systems and the amenities available to our workers. Only by proactively working together, can we effectively manage hazards and reduce the likelihood and severity of illness and injury.

  • Host Trading Name:

  • Host Business Name / Previous Name / Other Names (if applicable):

  • Host ABN:

  • Host Representative:

  • Risk Assessment Address and any Workplace location/s:

  • List the Area / Suburb/s and State this assessment is applicable to (i.e. "Forbes NSW" or "Hindmarsh / Prospect SA" or "Port Augusta Council Area SA"):

  • Date Completed:

  • Job Title of Placement/s:

  • Maxima Risk Assessor:

  • Risk Assessment Number (i.e. "01"):

  • Due date for next assessment:

Privacy & Information Collection Notice

  • Maxima are committed to preserving the confidentiality of information supplied to it by customers, potential customers, enterprises or individuals involved in joint or collaborative projects, trainees, on-hire employees, staff, jobseekers, participants and other agencies both government and non-government.

    Maxima will treat all such documents and information which comes to their knowledge, or to which they are exposed, as being strictly confidential. All documents, pictures, evidence gathered to complete this form are kept in a secure location and are only accessible by select employees of Maxima. Your information will not be given to any other person or agency unless you have given us permission or we are required to by law.

1. Host Work Health and Safety Systems

1.1 Safety Profile

  • Is there a current Safety Profile for this position and/or location with this host? (Maximum of 5 years expiry or less if there are any changes or at Maxima's discretion)

  • Have there been any changes to the WHS Management System, Supervisor or Safety Role Contacts since the completion of the Safety Profile? (Select all those that have changed)

  • No, the Safety Profile is up to date and requires no changes.

  • Yes, items within the Safety Management System require updating (i.e. Safe operating procedures, incident notification, etc).

  • Confirm that the current safety management system has the following elements by providing evidence of its implementation

  • Written Health and Safety Policy available to workers:

  • Please raise an action to develop a written health and safety policy that is readily available to all staff and satisfies the requirements as stated in WHS / OHS legislation.

    Hazard Picture.JPG
  • Please describe why this is not applicable:

  • Documented consultation, cooperation and communication procedure with an issue resolution process:

  • Please raise an action to develop and implement a written communication and consultation process with issue resolution that complies with the relevant: WHS / OHS legislation, workplace health and safety regulator requirements and the Code of Practice: Work health and safety consultation, co-operation and co-ordination

    Hazard Picture.JPG
  • Please describe why this is not applicable:

  • How will Maxima workers be consulted and communicated with?

  • Please describe the other methods for consulting with workers:

  • Documented incident management and investigation procedure:

  • Please raise an action to develop and implement an incident notification and investigation process that complies with the relevant: WHS / OHS legislation and workplace health and safety regulator requirements.

    Hazard Picture.JPG
  • How are incidents currently managed:

  • How will our workers notify your organisation of hazards and incidents:

  • Please describe:

  • Please describe why this is not applicable:

  • Documented hazard identification and risk assessment and management procedure/s:

  • Please describe why this is not applicable:

  • Please raise an action to develop and implement a risk management system that complies with the relevant: WHS / OHS legislation, workplace health and safety regulator requirements and the Code of Practice: How to manage work health and safety risks

    Hazard Picture.JPG
  • What is the current hazard and risk management process:

  • Please describe:

  • The provision of the necessary information, training or instruction for the worker/s by the host: (Select all that apply and provide evidence)

  • Provide evidence of all applicable safe work procedures:

  • Provide evidence of the site induction content / it's completion by worker:

  • Raise an action for host to develop and implement a host workplace induction prior to worker placement.

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  • Please describe why this is not applicable:

  • Raise an action for host to develop and implement a host workplace induction and relevant training prior to worker placement.

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  • Yes, the Supervisor details have changed.

  • Who will directly oversee the safety of our workers day-to-day? (Please list the name and contact details of all Supervisors)

  • Level of supervision to be provided:

  • Yes, the Safety Roles / RRTW Coordinator details have changed.

  • Please list the Name/s, Position/s and Contact Details (phone and or email) of the following:

  • Rehabilitation and Return to Work Coordinator (Name/s, Position/s, Contact/s):

  • Safety Officer (Name/s, Position/s, Contact/s):

1.2 Safety Management System Evidence

  • Confirm that the safety management system has the following elements by providing evidence of its implementation

  • 1.2.1 Written Health and Safety Policy available to workers:

  • Please raise an action to develop a written health and safety policy that is readily available to all staff and satisfies the requirements as stated in WHS / OHS legislation.

    Hazard Picture.JPG
  • Please describe why this is not applicable:

  • 1.2.2 Documented consultation, cooperation and communication procedure with an issue resolution process:

  • Please raise an action to develop and implement a written communication and consultation process with issue resolution that complies with the relevant: WHS / OHS legislation, workplace health and safety regulator requirements and the Code of Practice: Work health and safety consultation, co-operation and co-ordination

    Hazard Picture.JPG
  • Please describe why this is not applicable:

  • How will Maxima workers be consulted and communicated with?

  • Please describe the other methods for consulting with workers:

  • 1.2.3 Documented incident management and investigation procedure:

  • Please raise an action to develop and implement an incident notification and investigation process that complies with the relevant WHS / OHS legislation and workplace health and safety regulator requirements.

    Hazard Picture.JPG
  • How are incidents currently managed:

  • How will our workers notify your organisation of hazards and incidents:

  • Please describe:

  • Please describe why this is not applicable:

  • 1.2.4 Documented hazard identification and risk assessment and management procedure/s:

  • Please describe why this is not applicable:

  • Please raise an action to develop and implement a risk management system that complies with the relevant: WHS / OHS legislation, workplace health and safety regulator requirements and the Code of Practice: How to manage work health and safety risks

    Hazard Picture.JPG
  • What is the current hazard and risk management process:

  • Please describe:

  • 1.2.5 The provision of the necessary information, training or instruction for the worker/s by the host: (Select all that apply and provide evidence)

  • Provide evidence of all applicable safe work procedures:

  • Provide evidence of the site induction content / it's completion by worker:

  • Raise an action for host to develop and implement a host workplace induction prior to worker placement.

    Hazard Picture.JPG
  • Please describe why this is not applicable:

  • Raise an action for host to develop and implement a host workplace induction and relevant training prior to worker placement.

    Hazard Picture.JPG

1.3 Supervision

  • Who will directly oversee the safety of our workers day-to-day? (Please list the name and contact details of all Supervisors)

  • How will our workers be supported and supervised while on the job?

  • Workers will also be supervised by:

  • Please list the name, title and contact details of their Supervisor/s:

  • Level of supervision to be provided:

1.4 Safety Roles / RRTW Coordinator

  • Please list the Name/s, Position/s and Contact Details (phone and or email) of the following:

  • Rehabilitation and Return to Work Coordinator (Name/s, Position/s, Contact/s):

  • Safety Officer (Name/s, Position/s, Contact/s):

1.5 Skills, Experience and Checks

  • What experience or qualifications are required to perform this work?

  • Please describe:

1.6 Personal Protective Equipment (PPE) & Workwear

  • Select what PPE is required and who will provide it. Check against Supply Order (when available)

  • The Host will provide the following required PPE / Workwear:

  • List what class / type (i.e. Class 5, Double hearing protection, Earmuffs:

  • Additional items the Host is required to provide:

  • The Worker will provide the following required PPE / Equipment:

  • List what class / type (i.e. Class 5, Double hearing protection, Earmuffs:

  • Additional items the worker is required to provide:

  • Maxima will provide the following required PPE / Workwear:

  • List what class / type (i.e. Class 5, Double hearing protection, Earmuffs:

  • Additional items Maxima is required to provide:

1.7 Medicals and Health Monitoring

  • Is pre-employment screening, functional capacity or ongoing health monitoring required? (i.e. pre–employment medical, hearing tests, drug & alcohol testing)

  • HOST provided pre-employment screening or ongoing health monitoring (i.e. pre–employment medical, hearing tests, drug & alcohol testing).

  • Please describe:

  • MAXIMA provided pre-employment screening, functional capacity or ongoing health monitoring (i.e. pre–employment medical, hearing tests, drug & alcohol testing)

  • Please describe:

  • Do you require Maxima to arrange any pre-employment screening / medical prior to commencement? (Please list any special requirements (i.e. sleep test, full physical capabilities test, etc) in the "Note" section below.

Additional Comments & Photographic Evidence

  • Add additional comments here:

  • Additional Photos / Photographic Evidence

2. The Workplace

  • Have the Amenities (including First Aid and Emergency Response facilities) been checked within the last 12 months by Maxima?

2.1 Amenities

  • Provide photo evidence of the following amenities to show they are readily available to Maxima's worker/s and are provided in a safe, accessible and clean manner.

  • 2.1.1 Hand washing facilities

  • Please describe why this is not available or applicable:

  • Raise an action to rectify and describe or use a photo to explain the issue.

    Hazard Picture.JPG
  • 2.1.2 Toilets with adequate facilities, privacy and security

  • Please describe why this is not available or applicable:

  • Raise an action to rectify and describe or use a photo to explain the issue.

    Hazard Picture.JPG
  • 2.1.3 Filtered and / or cool drinking water

  • Please describe why this is not available or applicable:

  • Raise an action to rectify and describe or use a photo to explain the issue.

    Hazard Picture.JPG
  • 2.1.4 Eating facilities and appropriate areas to consume food (i.e. out of the sun)

  • Please describe why this is not available or applicable:

  • Raise an action to rectify and describe or use a photo to explain the issue.

    Hazard Picture.JPG
  • 2.1.5 Storage for personal belongings

  • Please describe why this is not available or applicable:

  • Raise an action to rectify and describe or use a photo to explain the issue.

    Hazard Picture.JPG
  • 2.1.6 The workplace (building, depot or vehicle) is kept: (select all that apply)

  • Provide photo evidence of workplace / workstation:

2.2 Emergency Response

  • 2.2.1 First Aid Facility Evidence:

  • The first aid facilities available:

  • Additional first aid facilities available:

  • Briefly describe what is in a poor condition / out of date or not available and raise action as required:

  • Appendix C of the First Aid in the Workplace Code of Practice outlines recommended first aid requirements, with the minimum for low risk workplaces being: 1 First Aider for every 50 workers, a basic first aid kit and a first aid room where there are 200 workers or more. Please note that a vehicle is considered a workplace when being driven for work purposes. https://www.safeworkaustralia.gov.au/system/files/documents/1908/code_of_practice_-_first_aid_in_the_workplace_0_0.pdf

    Hazard Picture.JPG
  • Please describe why this is not applicable:

  • Appendix C of the First Aid in the Workplace Code of Practice outlines recommended first aid requirements, with the minimum for low risk workplaces being: 1 First Aider for every 50 workers, a basic first aid kit and a first aid room where there are 200 workers or more. Please note that a vehicle is considered a workplace when being driven for work purposes. https://www.safeworkaustralia.gov.au/system/files/documents/1908/code_of_practice_-_first_aid_in_the_workplace_0_0.pdf

    Hazard Picture.JPG
  • 2.2.2 Fire Fighting Equipment Evidence:

  • The fire fighting equipment available:

  • Briefly describe what is in a poor condition / out of date or not available and raise action as required:

  • Briefly describe what additional equipment is available

  • Please describe what this is not applicable:

  • Please describe why this is not currently available or applicable:

  • 2.2.3 Emergency Response Evidence

  • The emergency response facilities available:

  • Additional emergency response equipment available:

  • Emergency plans and procedures relevant to the workplace must be implemented and tested at regular intervals for every workplace. Please note that a vehicle is considered a workplace when driven for work purposes.

    Hazard Picture.JPG
  • Briefly describe what is in a poor condition / out of date or not available and raise action as required:

  • Emergency plans and procedures relevant to the workplace must be implemented and tested at regular intervals for every workplace. Please note that a vehicle is considered a workplace when driven for work purposes.

    Hazard Picture.JPG
  • Please describe why this is not available or applicable:

  • 2.2.4 Are emergency exits / routes free of obstructions?

  • Immediately rectify or raise action if cannot be completed during the assessment.

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2.3 Incidents and Injuries

  • 2.3.1 What is the most common cause/s of injuries and/or incidents in the workplace:

2.1 Incidents and Injuries

  • 2.1.1 What is the most common cause/s of injuries and/or incidents in the workplace:

Additional Comments & Photographic Evidence

  • Add additional comments here:

  • Additional Photos / Photographic Evidence

3. The Work

    3.1 The Work

When completing this profile for more than 1 position, a separate "3.1 The Work" section must be completed for each job title.

  • 3.2 Job Title (only 1 can be listed in each section):

  • 3.3 Summary of job tasks:

  • 3.4 Work Arrangements:

  • 3.5 Shift Start Time/s - Finish Time/s: Break Time/s or break duration:

  • 3.6 Select the Work Activity:

  • 3.7 Equipment, tools and plant to be used (Please list or provide a photo of all plant/equipment/machinery/tools to be used):

  • Please describe:

  • Please describe or provide a photo of the tools / equipment above:

  • Select the controls in place:

  • Describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of plant in the workplace, Abrasive Blasting, Spray painting and powder coating, Welding processes, Excavation work, Demolition work, Construction work, etc) and their recommended controls, and raise an action for implementation if required.

    Hazard Picture.JPG
  • Select the controls in place for motor vehicle use:

  • Describe what other controls are in place:

  • A Maxima WHS Consultant may contact you for further information or to schedule a workplace inspection and risk assessment.

    Hazard Picture.JPG

4. Hazards in the workplace

  • Will the Job/Task require our worker to undertake or be exposed to any of the following? (select all that apply):

  • Biological materials (human waste, needle stick injury, blood, etc)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Confined Spaces

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Conveyor belt use

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Electricity or electrical shock hazards

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Falling objects

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

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  • Fast pace

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

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  • Fatigue

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Use / Store / Manufacture / Transport by worker

  • Attach photos below of:
    1. The hazardous substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk of injury through the contact, inhalation, ingestion and or physical reaction of hazardous chemicals or substances?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Stored on site, but worker would not have any contact with under usual work conditions.

  • Attach photos below of:
    1. The substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current level of risk from an incident involving the hazardous chemicals or substances on site?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous manual tasks (i.e. computer work)

  • Select how the hazard could occur:

  • Please describe:

  • Select the controls in place:

  • Please describe:

  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hot / cold work environments (i.e. cold air conditioning, near heat generating equipment)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Loud noise levels which exceed the regulated standard in the general work environment (i.e. large crowd in a hall, using a phone headset, etc)

  • Select the controls in place and provide photographic evidence:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

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  • Multiple PCBU's / businesses operating in the same work area

  • Select the controls in place:

  • Other controls in place are:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • On or near water

  • Select the controls in place:

  • Other controls in place are:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Personal threat / duress (i.e. interacting with members of the public either face-to-face or on the phone)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Pinch points

  • Select how the hazard could occur:

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Poor lighting / glare

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

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  • Remote or Isolated (being alone – work, travel etc)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Respirable dusts and or vapours (i.e. silica dust, asbestos, dust from abrasive blasting)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Slips, Trips or Falls (i.e. Stair use, uneven/slippery ground)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • With or near animals / exposed to bites or stings.

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Working at Heights

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

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  • Working from Home

  • Is or has a Maxima worker worked from home with this host?

  • Has the worker's home office / host's processes been previously assessed by Maxima and deemed appropriate?

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to review the process and ensure the worker has a safe home office if not all information is available.

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  • A separate review and assessment of the Host's working from home process is required. Please note, the worker may need to adhere to Maxima's process. Please attach all Policies, Procedures, Forms / Documents regarding working from home or send through to WHSAction@maxima.com.au.

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  • Working in the vicinity of mobile plant / vehicles / traffic

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

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  • Any other site specific hazards that Maxima need to be aware of?

  • Additional Hazards
  • Please describe how the hazard may occur:

  • What controls are in place?

  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Please describe work activity:

  • 3.7 Equipment, tools and plant to be used (Please list or provide a photo of all plant/equipment/machinery/tools to be used):

  • Please describe:

  • Please describe or provide a photo of the tools / equipment above:

  • 3.4.2 Select the controls in place:

  • Describe what other controls are in place:

  • A Maxima WHS Consultant may contact you for further information or to schedule a workplace inspection and risk assessment.

    Hazard Picture.JPG
  • Select the controls in place for motor vehicle use:

  • Describe what other controls are in place:

  • A Maxima WHS Consultant may contact you for further information or to schedule a workplace inspection and risk assessment.

    Hazard Picture.JPG

4. Hazards in the workplace

  • Will the Job/Task require our worker to undertake or be exposed to any of the following? (select all that apply):

  • Biological materials (human waste, needle stick injury, blood, etc)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Confined Spaces

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Conveyor belt use

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Electricity or electrical shock hazards

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Falling objects

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Fast pace

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Fatigue

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Use / Store / Manufacture / Transport by worker

  • Attach photos below of:
    1. The hazardous substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk of injury through the contact, inhalation, ingestion and or physical reaction of hazardous chemicals or substances?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Stored on site, but worker would not have any contact with under usual work conditions.

  • Attach photos below of:
    1. The substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current level of risk from an incident involving the hazardous chemicals or substances on site?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous manual tasks (i.e. computer work)

  • Select how the hazard could occur:

  • Please describe:

  • Select the controls in place:

  • Please describe:

  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hot / cold work environments (i.e. cold air conditioning, near heat generating equipment)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Loud noise levels which exceed the regulated standard in the general work environment (i.e. large crowd in a hall, using a phone headset, etc)

  • Select the controls in place and provide photographic evidence:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Multiple PCBU's / businesses operating in the same work area

  • Select the controls in place:

  • Other controls in place are:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • On or near water

  • Select the controls in place:

  • Other controls in place are:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Personal threat / duress (i.e. interacting with members of the public either face-to-face or on the phone)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Pinch points

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Poor lighting / glare

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Remote or Isolated (being alone – work, travel etc)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Respirable dusts and or vapours (i.e. silica dust, asbestos, dust from abrasive blasting)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Slips, Trips or Falls (i.e. Stair use, uneven/slippery ground)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • With or near animals / exposed to bites or stings.

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Working at Heights

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Working from Home

  • Is or has a Maxima worker worked from home with this host?

  • Has the worker's home office / host's processes been previously assessed by Maxima and deemed appropriate?

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to review the process and ensure the worker has a safe home office if not all information is available.

    Hazard Picture.JPG
  • A separate review and assessment of the Host's working from home process is required. Please note, the worker may need to adhere to Maxima's process. Please attach all Policies, Procedures, Forms / Documents regarding working from home or send through to WHSAction@maxima.com.au.

    Hazard Picture.JPG
  • Working in the vicinity of mobile plant / vehicles / traffic

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Any other site specific hazards that Maxima need to be aware of?

  • Please describe how the hazard may occur:

  • What controls are in place?

  • 3.7 Equipment, tools and plant to be used (Please list or provide a photo of all plant/equipment/machinery/tools to be used):

  • Please describe:

  • Please describe or provide a photo of the equipment above:

  • 3.4.2 Select the controls in place:

  • Describe what other controls are in place:

  • A Maxima WHS Consultant may contact you for further information or to schedule a workplace inspection and risk assessment.

    Hazard Picture.JPG
  • Select the controls in place for motor vehicle use:

  • Describe what other controls are in place:

  • A Maxima WHS Consultant may contact you for further information or to schedule a workplace inspection and risk assessment.

    Hazard Picture.JPG

4. Hazards in the workplace

  • Will the Job/Task require our worker to undertake or be exposed to any of the following? (select all that apply):

  • Biological materials (human waste, needle stick injury, blood, etc)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Confined Spaces

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Conveyor belt use

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Electricity or electrical shock hazards

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Falling objects

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Fast pace

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Fatigue

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Used / Handled by worker

  • Attach photos below of:
    1. The substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current level of risk from an incident involving the hazardous chemicals or substances on site?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Stored on site, but worker would not have any contact with under usual work conditions.

  • Attach photos below of:
    1. The substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current level of risk from an incident involving the hazardous chemicals or substances on site?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous manual tasks (i.e. computer work)

  • Select how the hazard could occur:

  • Please describe:

  • Select the controls in place:

  • Please describe:

  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hot / cold work environments (i.e. cold air conditioning, near heat generating equipment)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Loud noise levels which exceed the regulated standard in the general work environment (i.e. large crowd in a hall, using a phone headset, etc)

  • Select the controls in place and provide photographic evidence:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Multiple PCBU's / businesses operating in the same work area

  • Select the controls in place:

  • Other controls in place are:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Personal threat / duress (i.e. interacting with members of the public either face-to-face or on the phone)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Pinch points

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Poor lighting / glare

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Remote or Isolated (being alone – work, travel etc)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Respirable dusts and or vapours (i.e. silica dust, asbestos, dust from abrasive blasting)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Slips, Trips or Falls (i.e. Stair use, uneven/slippery ground)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • With or near animals / exposed to bites or stings.

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Working at Heights

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Working from Home

  • Is or has a Maxima worker worked from home with this host?

  • Has the worker's home office / host's processes been previously assessed by Maxima and deemed appropriate?

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to review the process and ensure the worker has a safe home office if not all information is available.

    Hazard Picture.JPG
  • A separate review and assessment of the Host's working from home process is required. Please note, the worker may need to adhere to Maxima's process. Please attach all Policies, Procedures, Forms / Documents regarding working from home or send through to WHSAction@maxima.com.au.

    Hazard Picture.JPG
  • Working in the vicinity of mobile plant / vehicles / traffic

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Any other site specific hazards that Maxima need to be aware of?

  • Please describe how the hazard may occur:

  • What controls are in place?

  • 3.7 Equipment, tools and plant to be used (Please list or provide a photo of all plant/equipment/machinery/tools to be used):

  • Please describe:

  • 3.4.2 Select the controls in place:

  • Describe what other controls are in place:

  • A Maxima WHS Consultant may contact you for further information or to schedule a workplace inspection and risk assessment.

    Hazard Picture.JPG
  • Select the controls in place for motor vehicle use:

  • Describe what other controls are in place:

  • A Maxima WHS Consultant may contact you for further information or to schedule a workplace inspection and risk assessment.

    Hazard Picture.JPG

4. Hazards in the workplace

  • Will the Job/Task require our worker to undertake or be exposed to any of the following? (select all that apply):

  • Biological materials (human waste, needle stick injury, blood, etc)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Confined Spaces

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Conveyor belt use

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Electricity or electrical shock hazards

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Falling objects

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Fast pace

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Fatigue

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Use / Store / Manufacture / Transport by worker

  • Attach photos below of:
    1. The hazardous substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk of injury through the contact, inhalation, ingestion and or physical reaction of hazardous chemicals or substances?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous Chemicals - Stored on site, but worker would not have any contact with under usual work conditions.

  • Attach photos below of:
    1. The substances / chemicals or materials present in their storage area;
    2. Any PPE, spill clean up or spill containment kits and their contents; and
    3. Safety Data Sheets and their location.

    Review the changes to workplace chemical laws and any applicable guidance materials under GHS 7: https://www.safeworkaustralia.gov.au/collection/ghs-7-guidance-material
    NOTE: Users should not accept hazardous chemicals manufactured or imported on or after 1 January 2023 unless they are classified and labelled in accordance with GHS 7 and have SDS prepared in accordance with GHS 7.

  • List or photograph the type of chemicals or substances the worker may use / handle / come into contact with:

  • The other types of chemicals / substances the worker may come into contact with:

  • Select the controls in place and or provide photographic evidence:

  • Please describe what other controls are in place:

  • Review all applicable Codes of Practice (i.e. Managing risks of hazardous chemicals in the workplace, Labelling of workplace hazardous chemicals, etc) and raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current level of risk from an incident involving the hazardous chemicals or substances on site?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hazardous manual tasks (i.e. computer work)

  • Select how the hazard could occur:

  • Please describe:

  • Select the controls in place:

  • Please describe:

  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • Hot / cold work environments (i.e. cold air conditioning, near heat generating equipment)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Loud noise levels which exceed the regulated standard in the general work environment (i.e. large crowd in a hall, using a phone headset, etc)

  • Select the controls in place and provide photographic evidence:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Multiple PCBU's / businesses operating in the same work area

  • Select the controls in place:

  • Other controls in place are:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • On or near water

  • Select the controls in place:

  • Other controls in place are:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Personal threat / duress (i.e. interacting with members of the public either face-to-face or on the phone)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Pinch points

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Poor lighting / glare

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Remote or Isolated (being alone – work, travel etc)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Respirable dusts and or vapours (i.e. silica dust, asbestos, dust from abrasive blasting)

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Slips, Trips or Falls (i.e. Stair use, uneven/slippery ground)

  • Select the controls in place:

  • Describe what other controls are in place:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • With or near animals / exposed to bites or stings.

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Working at Heights

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Working from Home

  • Is or has a Maxima worker worked from home with this host?

  • Has the worker's home office / host's processes been previously assessed by Maxima and deemed appropriate?

  • A separate review and assessment of the Host's working from home process is required. Please note, the worker may need to adhere to Maxima's process. Please attach all Policies, Procedures, Forms / Documents regarding working from home or send through to WHSAction@maxima.com.au.

    Hazard Picture.JPG
  • A separate review and assessment of the Host's working from home process is required. Please note, the worker may need to adhere to Maxima's process. Please attach all Policies, Procedures, Forms / Documents regarding working from home or send through to WHSAction@maxima.com.au.

    Hazard Picture.JPG
  • A separate review and assessment of the Host's working from home process is required. Please note, the worker may need to adhere to Maxima's process. Please attach all Policies, Procedures, Forms / Documents regarding working from home or send through to WHSAction@maxima.com.au.

    Hazard Picture.JPG
  • Working in the vicinity of mobile plant / vehicles / traffic

  • Select the controls in place:

  • Please describe:

  • What is the current risk?

  • Raise an action to consider and implement controls to reduce the level of risk.

    Hazard Picture.JPG
  • What is the residual risk?

  • Raise an action to consider and implement additional controls to reduce the level of risk.

    Hazard Picture.JPG
  • Any other site specific hazards that Maxima need to be aware of?

  • Please describe how the hazard may occur:

  • What controls are in place?

Additional Comments & Photographic Evidence

  • Add additional comments here:

  • Additional Photos / Photographic Evidence

6. Sign Off

6.1 Host Declaration

  • I have provided to the best of my knowledge accurate information regarding the work tasks, hazards and controls involved.

  • As per workplace health and safety legislation, I understand that I must consult with Maxima and their workers of all changes to job tasks / role requirements (including the use of any additional tools, plant or equipment and documented procedures), amenities provided, first aid and emergency response equipment that could impact the health and safety of Maxima workers which have not been included in this risk assessment. I also understand that these changes may need to be assessed by Maxima and could trigger a risk assessment or workplace visit.

  • I understand that Maxima will need to maintain regular contact and monitoring of Maxima workers as per the relevant Government Regulator and Legislation or Labour Hire Licensing requirements. This may also include the need to conduct additional workplace inspections / risk assessments on site or remotely.

  • I understand that Maxima must be notified within 24 hours of all injuries or incidents that have the potential to result in an injury; with any notifiable incidents (the death of a person, a serious injury or illness, or a dangerous incident) reported to Maxima immediately or as soon as practicable and the relevant WHS Regulator notified.

  • Host Representative Name & Signature:

  • Date & Time Completed:

6.2 Risk Assessor Sign Off

  • Based on the items assessed, made available and discussed (select applicable statement):

  • Maxima Consultant Name & Signature:

  • Date & Time Completed:

  • Additional Comments:

Document Control

Version Control

Document Owner & Approval

  • Position: Risk and Quality Manager

  • Incumbent: Naomi Miranda

  • Approval Date: 26/05/2021

Review Date

  • Document Review Date: 26/05/2024

Version Control

  • 28/01/2021 - GF 101-11 (1): Version Details: Creation of new template in iAuditor as per the Maxima Project - Paper-less Risk Assessments. See Maxima's Document Control Register for detailed historical information.

    THIS VERSION WAS ARCHIVED 26/05/2021

    Author: Katherine Parr
    Reviewer/s: Naomi Miranda, Sue Worrall, Steve Hutchinson

  • 24/03/2021 - GF 101-11 (1): Update to Instructions for Completion section only.

  • 26/05/2021 - GF 101-11 (2): Version Details: Added "Additional Photos / Photographic Evidence" section at the bottom of each page for optional use. Added Working from Home as a risk. Added "Host Business Name / Previous Name / Other Names (if applicable):" and updated "This assessment was conducted in "Suburb State" (i.e. "Hindmarsh SA"):" TO "List the Area / Suburb/s and State this assessment is applicable to (i.e. "Forbes NSW" or "Hindmarsh / Prospect SA" or "Port Augusta Council Area SA"):" on the Title Page and Updated the Disclaimer, Doc Control Section and Instructions for Completion.

    Author: Katherine Parr
    Reviewer/s: Naomi Miranda, Sue Worrall, Steve Hutchinson

Instructions for Completion

When to use this form

  • This form can only be completed by a competent Maxima-appointed Risk Assessor (holds at least a Certificate IV in WHS or equivalent and has received instruction on the use of this template).
    This form must be used to assess all Category 3 (high risk) work activities in the following instances:

    1. Prior to the placement of Maxima hosted workers;
    2. At regular intervals as determined by a Maxima Consultant or WHS Consultant based on risk (recommend 1 yearly intervals for high risk qualified workers (i.e. not trainees), Maximum review is 3 years);
    3. When the main workplace location changes to a new location that does not have a current safety profile for that role (i.e. worker is transferred to a different branch);
    4. When the worker is required to undertake new / additional tasks that have not been assessed or discussed previously with Maxima (i.e. worker receives a promotion, gets transferred to a different department or is seconded to an alternative role).

    This form can also be used to assess Category 1 & 2 work activities when deemed necessary by a Maxima Risk Assessor. Completed forms are to be downloaded as a pdf and submitted via email to: WHSAction@maxima.com.au.

How to complete this form

  • PLEASE NOTE: This form is best completed using the iAuditor mobile phone app. If you are unable to export and email via your phone, you can log on to the web based platform (https://app.safetyculture.com/).

    The Risk Assessor is to complete each section of this form by:

    1. Reviewing any previous Self-Assessments, Safety Profiles or Risk Assessments for the Host & Job Title prior to arriving at the Host work location;
    2. Asking the Host’s representative to respond to each of the questions;
    3. Discussing the hazards involved with completing our worker's job tasks and visually inspecting their controls;
    4. Recording the Host’s responses and adding relevant details in the "Note" section to accurately describe the workplace or job task;
    5. Inspecting the workplace for hazards, visually confirming that the amenities provided are clean and adequate and all basic safety systems (i.e. evacuation plans, first aid facilities, fire safety equipment) are in working order and readily available;
    6. Gathering photographic evidence of the above (first aid kit maintenance logs, eating facilities available, fire extinguisher test tags), or obtaining copies of relevant documentation as required (i.e. Completed site induction, WHS Policy, Work Instructions);
    7. Capturing any corrective actions, via the Action button, enter a brief description on 'What needs to be done?', add a detailed description as to what and why, Assign it to a Maxima user (for internal staff only) or the relevant Host representative by manually entering their email address;
    8. Ensuring the Host representative agrees with any corrective actions required and have them sign and date Section 6;
    9. The Risk Assessor signing and dating Section 6 and then marking the form as "complete".
    10. Download the pdf version of this form and email it to WHSAction@maxima.com.au.

Risk Assessment Matrix & Controls

  • Where practicable, refer to Safe Work Australia Code of Practices for Managing the risk of falls at workplaces, Managing noise and preventing hearing loss in the workplace, Hazardous manual tasks in the workplace and Managing the risks of hazardous chemicals in the workplace or any other applicable codes.

    For an up-to-date Code of Practice, visit Safe Work Australia: https://www.safeworkaustralia.gov.au/resources_publications/model-codes-of-practice

  • The Risk Evaluation Matrix is used to assess the risk associated with the host employer hazards. In line with section 3 of the Model Code of Practice: How to manage work health and safety risks (https://www.safeworkaustralia.gov.au/book/model-code-practice-how-manage-work-health-and-safety-risks#3-step-2how-to-assess-risks), Maxima recognises that many hazards and their associated risks are well known and have well established and accepted control measures. Furthermore, Maxima acknowledges the hazard identification and risk assessment process conducted by host employers prior to or as a result of engaging Maxima. Maxima risk assessors must have completed at least a Certificate IV in WHS and Maxima specific training prior to conducting a risk assessment. As such, Maxima consultants will only assess the residual risk rating following control implementation or the current risk rating for those risks with no controls, crediting the host employer's hazard identification, assessment and control process.

    Talk to the host and document the control measures in place. The Hierarchy of Controls is a useful tool to qualify a lower risk rating. Further information on Maxima’s Hazard Management process is in Hazard and Risk Management Procedure WHSPR 007.

    Risk Evaluation Matrix.PNG
  • Hierarchy of Controls: The most effective control measures should be considered .

    HOC.jpg

Tips on use

Item/Question Explanations

  • - TITLE PAGE: "Risk Assessment Address and Workplace location/s:" : Risk Assessor to list the address where the risk assessment took place and or the main workplace location/s (offices / depots / Warehouses areas/suburbs serviced or required to potentially visit), i.e. "Risk Assessment took place at: Fake Court, Killburn, SA, 5084 - work will be performed at various work sites throughout the Enfield Council District / Gold Coast region / suburbs of Caboolture, Bribie and Petrie". Full addresses are not required so long as the Host can identify the address by the name of the depot / office if required.

  • - Section 3.1: You can complete one form for multiple roles, however, you must create a new Section 3.1 for each role separately if there are different tasks / risks involved.

Adding Notes, Media & Actions

  • Screenshot - Notes Media and Action.JPG

Adding Media (i.e. Photographic Evidence or PDF Documents))

  • PHOTOGRAPHIC EVIDENCE
    - To save you time, you can attach a photo of the item of a document as evidence without having to type notes or select items provided others can clearly identify what the picture is of and it clearly depicts the state of the item/s.
    - Otherwise, if you didn’t get enough time to take a photo, the host was going to email you a document, the equipment wasn’t available due to being serviced or in use elsewhere, you were asked not to by the host due to privacy or it seemed inappropriate at the time (i.e. taking a photo of the toilets whilst someone is in there) you can select what was available or write it as a note. Add an action for the host to send you that document. And if you saw the item but didn’t take a picture you can select that you have seen the item and list what was available to the worker.

  • PDF / EVIDENCE OF DOCUMENTS
    - Similarly to photographic evidence, you can also attach pdf versions of a document (i.e. a safe work procedure), etc. You can do this either by uploading it using the web application (https://app.safetyculture.com/) or

  • "Additional Comments & Photographic Evidence"
    - There is a section on most pages with the heading "Additional Comments & Photographic Evidence" . Here you can document info or save photos relevant to that page if you do not have the time during the on site visit to add them to each individual question. You do not have to re-add the photos to each question, but you will need to select or write a note that you've added photos in another area.

Adding Notes

  • NOTES
    - You can add additional details in the "Note" section to accurately describe the workplace, job task or provide extra context to an answer.

Adding Actions

  • ACTIONS
    - You can assign corrective actions directly to a host, however, the moment you add their email they get a notification. Only add the host email after you are completely satisfied with your action heading, detailed description, and have an agreed due date.
    - The email field will automatically populate with Maxima users, so you will need to add their email in manually, see here: https://help.safetyculture.com/en_us/1063649994-r17cDFED

  • DUPLICATE INSPECTIONS / MULTIPLE ROLE ASSESSMENT:
    - All of your iAuditor forms/inspections are able to be duplicated during any stage of the process, even after you have marked it complete. You can only duplicate items using your mobile phone only. However, YOU MUST ONLY DUPLICATE FORMS THAT ARE IN THE CURRENT TEMPLATE VERSION (i.e. it is not recommended to duplicate the previous risk assessments when re-assessing a host unless it was completed in the same template as the current and correct version). For instructions on how to duplication an inspection, please see: https://help.safetyculture.com/en_us/1063715646-rJQlIPKNP

    - Alternatively, you can also use Section 3.1 of this form to add in multiple roles with the same host, however, you must create a new Section 3.1 for each role separately if there are different tasks / risks involved. This is not mandatory and you are most welcome to use the duplication feature instead.

  • EXPORTING FORMS

    - You can only export / download forms that have been marked COMPLETE on your phone, there is no option to do so for incomplete forms.
    - Instructions on how to export this form can be found here: https://support.safetyculture.com/reports/export-inspection-reports-to-pdf-and-word/

  • EDITING POST COMPLETION

    - You can edit this form even after you have marked it as complete.

  • SAVE YOUR FORM REGULARLY ON THE MOBILE APP
    - Saving along the way can help avoid any data loss.
    - To do this, scroll up until you see the 3 vertical dots on the right hand side;
    - Click on the 3 dots and select "Save as in progress";
    - Then select "SAVE" to save your work and leave the inspection, or "CONTINUE INSPECTION' to save your work but keep going with the inspection.

    NOTE: The web based version automatically saves, so you do not need to manually save.

  • COMPLETING INSPECTIONS OUT OF RANGE / OFFLINE
    - All templates can be completed offline (i.e. in airplane mode/in areas with no reception), however, you must sign into iAuditor BEFORE you go out of mobile / network reception range / board a plane so you can access the template and commence an inspection.
    - For further information on how to conduct an inspection whilst offline please see: https://help.safetyculture.com/en_us/1064239831-r1marwYNP

  • SYNC YOUR PROFILE
    - Before leaving reception / wifi area and on returning to network connection make sure you manually sync your mobile app.
    - Please see how to manually sync the iAuditor mobile app here: https://help.safetyculture.com/en_us/1063683217-Byt2awFEw
    - For information on iAuditor mobile app syncing troubleshooting and settings, please see here: https://help.safetyculture.com/en_us/1063978168-Sy3T6wFVP

  • PACK A PEN!
    - You may need a pen to sign off on the form if you have a protective glass cover.

  • MORE INFO

    - Further information on conducting inspections can be found here: https://help.safetyculture.com/en_us/categories/inspections-S1tBOO3Qw

TROUBLESHOOTING

  • - If you are unable to mark the risk assessment as complete, ensure you have answered all of the mandatory questions (they are marked with an *).

    - You can add additional details in the "Note" section to accurately describe the workplace, job task or provide extra context to an answer.

    - For further information on iAuditor mobile app errors, see: https://help.safetyculture.com/en_us/1498808456-ryNoE2YSw

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.