Assessment

Hazard Identification

Enter description of procedure, task or worksite being assessed

Biological (e.g. hygiene, disease, infection)

Are there biological hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard

Choose the type of hazard

Kindly specify

Description of hazard

Add media
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Chemicals

Are there chemical hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard

Choose the type of hazard

Description of hazard

Photo of hazard (optional)

Name of chemical(s) / Details

Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Critical Incident

Are there critical hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard

Choose type of hazard resulting in:

Kindly specify

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Energy Systems

Are there energy system hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard

Choose the type of hazard / incident or issues involving:

Kindly specify

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Environment

Are there environment hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard
Choose type of hazard

Kindly specify

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Facilities / Built Environment

Are there facilities / built environment hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard
Choose type of hazard

Kindly specify

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Machinery, Plant and Equipment

Are there machinery, plant and equipment hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard

Choose type of hazard

Kindly specify

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Manual Tasks / Ergonomics

Are there manual tasks / ergonomics hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard

Choose type of hazard

Kindly specify

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

People

Are there people hazards observed?

Click Add Hazard after you have observed and identified a hazard

Hazard
Choose type of hazard

Kindly specify

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

Others

Are there any other hazards not listed above?

Click Add Hazard after you have observed and identified a hazard

Hazard

Description of hazard

Photo of hazard (optional)
Risk rating

Consequence

Likelihood

Risk rating

Controls
Select control measures

Kindly specify

References

Risk Matrix Reference

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Hierarchy of Controls Reference

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Monitor and Review Controls

Are the planned control measures sufficient and effective in minimizing the level of risk?

Have there been any changes to the planned control measures?

Are further control measures required in future?

Completion

Recommendations

Full Name and Signature of the Inspector