Housing WA - Site Risk Assessment Form

• INSTRUCTIONS: This form is used as part of the Operational Process for each Business Unit. This form fulfils part of our legal obligations to ensure a safe and environmentally responsible service with a quality outcome for our customers.
  PLEASE NOTE: By completing this form people do not incur additional legal responsibilities. Completing this form will only help demonstrate our efforts to perform the work with care.
  

• Add location
  Address

• Customer:

  Select Dept. of Housing WA GROH

  • Dept. of Housing WA
  • GROH

• Conducted on

  Date

• Branch:

  Metro South

  South West

  Great Southern

  Other

• Other Branch:

• Prepared by:

  Select James Price Graham Byles Martin Godden Jen Harvey Michael Hardman Peter Caselton Tem Haines Stephen Bull Other

  • James Price
  • Graham Byles
  • Martin Godden
  • Jen Harvey
  • Michael Hardman
  • Peter Caselton
  • Tem Haines
  • Stephen Bull
  • Other

• Prepared by:

• Job Number:

HAZARD CHECKLIST and RISK RATING SCALE

• Use of Ladders

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Confined Space

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Dangerous Substances (DG/Haz Sub)

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Asbestos Substrates

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Dust

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Electricity

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Overhead Power Lines

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Gas

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Lead

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Noise

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Radio Frequency (RF)

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Exposure to Ultra Violet (UV)

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Fall from Height >1.8m

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Falling Objects from Above

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Flying Debris and Objects

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• High Pressure Equipment in Use

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Hot Objects or Extreme Heat

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Environmental Impacts

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Impact on Air Quality

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Impact on Soil Quality

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Impact on Water Quality

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Impact on Surrounding Community

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Machinery Operating in Vicinity

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Vehicle Movements in Proximity

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Potential Damage to Customer or Public Asset

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Public Access

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Slippery Surfaces

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Uneven Ground Areas (Scaffold, Ladders etc.)

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Working on Roofs

  Select 5. Extreme - Very risky, likely to cause very serious harm. 4. High - Marked risk, clear potential for serious harm. 3. Medium - Level of risk similar to risk associated with driving a car. 2. Low - Marginal risk with little likelihood of any harm. 1. Negligible - Virtually harmless. 0. N/A - This hazard is not thought to exist on this site.

  • 5. Extreme - Very risky, likely to cause very serious harm.
  • 4. High - Marked risk, clear potential for serious harm.
  • 3. Medium - Level of risk similar to risk associated with driving a car.
  • 2. Low - Marginal risk with little likelihood of any harm.
  • 1. Negligible - Virtually harmless.
  • 0. N/A - This hazard is not thought to exist on this site.

• STOP THE JOB!
  
  Requires GM level approval to proceed.

• Controls Required:

• STOP WORK!
  
  Reassess and find better way to work.
  Requires GM level approval to proceed.

• Controls Required:

• Control risk and monitor to ensure controls work.

• Controls Required:

• Monitor work to ensure risk remains low.

• Controls required:

• Continue work.

• Other: Specify

  5. Extreme

  4. High

  3. Medium

  2. Low

  1. Negligible

• Other: Specify

  5. Extreme

  4. High

  3. Medium

  2. Low

  1. Negligible

• Hazard photos

  Media

• I have reviewed the work scope & identified hazards that form part of that work scope & I confirm the controls above are adequate. I accept the controls above and will enforce them on site.

  Sign

POTENTIAL CONTROLS: Please Note: This list is not exhaustive of all PPE required on site. All relevant MSDS, SWMS, JSEA and other work related documentation must be consulted when considering PPE for this job.

• Potential Controls

  Select Barricades Eye Protection Gloves Safety Boots Hard Hat Hearing Protection High Vis Clothes Scaffold Electrical Lock Out/Tag Out Harness/Fall Arrest Travel Tower/Platform

  • Barricades
  • Eye Protection
  • Gloves
  • Safety Boots
  • Hard Hat
  • Hearing Protection
  • High Vis Clothes
  • Scaffold
  • Electrical Lock Out/Tag Out
  • Harness/Fall Arrest
  • Travel Tower/Platform

• Safe Work Method Statements to Use

• Safe Work Practices to Follow

• Other Controls: