Hazard/ Risk Analysis

• Document No.

• Audit Title

• Location
  Address

• Conducted on

  Date

• Prepared by

• Type of Work:

  Select safe work method statement hazard/ risk analysis

  • safe work method statement
  • hazard/ risk analysis

• Sign Off:

  daily

  event duration

  project duration

• Qualifications required:

  Yes

  No

• Plant and equipment required:

• High Risk: construction work (as per regulation 291) WHS Act, 2012 & Associated Codes of Practice
  http://www.thelaw.tas.gov.au/tocview/content.w3p;cond=;doc_id=%2B122%2B2012%2BGS291%40EN%2B20150928000000;histon=;inforequest=;prompt=;rec=;term=

• Working on/ near roadway?

• Traffic management plan attached?

  Yes

  No

  N/A

• Other location?

Warnings

• Sign

• Barricades

• Safety tape

• Solid barriers

• Other (list)

• Personal protective equipment required:

  Yes

  No

  N/A

• Safety glasses

• Safety boots

• Respiratory protection

• Earmuffs

• Coveralls

• Welding shield

• Gloves

• Safety helmet with face guard

• Self-contained breathing apparatus

• Hi-vis safety vest

• Face shield

• Safety harness

• Cut resistant chaps/ trousers to standard AS/NZS 4453

• Associated procedures/ permits work instruction:

Describe the task/ step/ action

• List logical task, step or action

Identify the hazards/ risks/ potential incidents

• What type of incidents/ injuries can happen?

Score before controls

• Use risk matrix

• Likelihood

  1

  2

  3

  4

  5

• Consequence

  1

  2

  3

  4

  5

• Risk

  L

  M

  S

  H

Hazard/ risk control or action

• List your controls. Consider hierarchy of controls

Score after controls

• Use risk matrix

• Likelihood

  1

  2

  3

  4

  5

• Consequence

  1

  2

  3

  4

  5

• Risk

  L

  M

  S

  H

• Summary

• Recommendations

Complete below where additional hazards/ potential incidents are identified during work:

• Select date

  Date

• Describe task

• Hazards/ potential incidents

• Likelihood

  1

  2

  3

  4

  5

• Consequence

  1

  2

  3

  4

  5

• Risk

  L

  M

  S

  H

• Risk control or action

• Likelihood

  1

  2

  3

  4

  5

• Consequence

  1

  2

  3

  4

  5

• Risk

  L

  M

  S

  H

• Read & Signed by all persons participating:

• Have all risks been reduced to an acceptable level (as low as reasonably practical) AND controls implemented?

  Yes

  No

  N/A

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Risk matrix

  

• Sources of Harm
  *How to manage Health & Safety Risks Code of Practice 2011

  

• 

• Document Information: