HSE Risk Assessment

• Client / Site

• Date and Time of Inspection

  Date

• Inspected by

• Location
  Address

Hazard Identification

• Enter description of procedure, task or worksite being assessed

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

• Are there biological hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose the type of hazard

  Blood / Bodily fluid

  Virus / Disease

  Food handling

  Other

• Kindly specify

• Description of hazard

• Add media

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Chemicals

• Are there chemical hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose the type of hazard

  Non-hazardous chemical(s)

  Hazardous chemical(s)

• Description of hazard

• Photo of hazard (optional)

  Media

• Name of chemical(s) / Details

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Critical Incident

• Are there critical hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose type of hazard resulting in:

  Lockdown

  Evacuation

  Disruption

  Others

• Kindly specify

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Energy Systems

• Are there energy system hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose the type of hazard / incident or issues involving:

  Electricity (incl. Main and Solar)

  LPG Gas

  Gas / Pressurized containers

  Other

• Kindly specify

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Environment

• Are there environment hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose type of hazard

  Select Sun exposure Water (creek, river, beach, dam) Sound / Noise Animals / Insects Storms / Weather Temperature (heat, cold) Other

  • Sun exposure
  • Water (creek, river, beach, dam)
  • Sound / Noise
  • Animals / Insects
  • Storms / Weather
  • Temperature (heat, cold)
  • Other

• Kindly specify

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Facilities / Built Environment

• Are there facilities / built environment hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose type of hazard

  Select Buildings and fixtures Driveway / Paths Workshops / Work rooms Playground equipment Furniture Swimming pool Other

  • Buildings and fixtures
  • Driveway / Paths
  • Workshops / Work rooms
  • Playground equipment
  • Furniture
  • Swimming pool
  • Other

• Kindly specify

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Machinery, Plant and Equipment

• Are there machinery, plant and equipment hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose type of hazard

  Machinery (fixed plant)

  Machinery (portable)

  Hand tools

  Vehicles / trailers

  Other

• Kindly specify

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Manual Tasks / Ergonomics

• Are there manual tasks / ergonomics hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose type of hazard

  Manual tasks (repetitive, heavy)

  Working at heights

  Restricted space

  Other

• Kindly specify

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

People

• Are there people hazards observed?

  Safe

  At Risk

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Choose type of hazard

  Select Students Staff Parents Physical Psychological / Stress Other

  • Students
  • Staff
  • Parents
  • Physical
  • Psychological / Stress
  • Other

• Kindly specify

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

Others

• Are there any other hazards not listed above?

  Yes

  No

  N/A

• Click Add Hazard after you have observed and identified a hazard

Hazard

• Description of hazard

• Photo of hazard (optional)

  Media

Risk rating

• Consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Kindly specify

References

• Risk Matrix Reference

• Hierarchy of Controls Reference

Monitor and Review Controls

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

  Yes

  No

  N/A

• Have there been any changes to the planned control measures?

  No

  Yes

  N/A

• Are further control measures required in future?

  No

  Yes

  N/A

Completion

• Recommendations

• Full Name and Signature of the Inspector

  Sign