QPRC HSEQ Risk Assessment Form

• This inspection form is to be used by all QPRC Staff that require to do a Risk Assessment in accordance with WHS Operational Risk Management Process.
  
  Instructions:
  -------------------------------------
  1. Start the inspection by taking a photo of the Site being Inspected.
  2. Answer each item.
  3. Add photos and notes by clicking on the paperclip icon.
  4. To add a Corrective Measure click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority and due date.
  5. Complete Risk Assessment by providing digital signature and selecting "Mark as Complete".
  6. Share your report by exporting as PDF.

• Take a photo of area Risk Assessment is being conducted on?

  Media

• Conducted on

  Date

• Prepared by

• Location
  Address

• Record No: C17165558 Version 1 Issue Date: 05/03/18 This is a controlled document. Before using this document, ensure it is the latest version by checking QPRC’s intranet, website or Electronic Document Register Management System (EDRMS). Printed or downloaded versions of this document are uncontrolled.

Site Details

• Vehicle No/ Site Name?

• Team Name?

• Email ID?

• Mobile Number?

• Job No (if applicable)?

• Weather Conditions?

• Changes to planned work?

• Number of Contractors onsite? Are they inducted to site and if applicable listed in BNG Conserve as Approved Contractors (only for contractors not engaged through Procurement Panels)?

Are there any SWMS or SOPS applicable to this job or operation?

• List all applicable SWMS applicable to this job or operation?

SWMS

• SWMS Number and title

• Is it Compliant to Site?

  Yes

  No

  N/A

• Hazards and Related Risks NEED to be completed prior to commencing work.
  * Control measures documented are implemented on site. Newly identified hazards, risks and controls are documented below.

• List all applicable SOPs applicable to this job or operation?

SOPs

• SOP Number and title?

• Is it Compliant to Site?

  Yes

  No

  N/A

• Hazards and Related Risks NEED to be completed prior to commencing work.
  * Control measures documented are implemented on site. Newly identified hazards, risks and controls are documented below.

• Risk Matrix

  

• Hierarchy of Control

  

• Hazard and Related Risks?

Hazard and Related Risks

Using the above Risk Matrix rate the Hazard and Related Risks for the job in the Uncontrolled Hazards and Risks, and then rate the same job after placing Controls in place.

• Uncontrolled Hazards and Risks?

  Extreme

  Significant

  Moderate

  Minor

  NA

• Controls and Measures?

  Extreme

  Significant

  Moderate

  Minor

  NA

Roadwork Speed Limit Record?

• On-site Supervisor:

• Does this site Require Traffic Management

  Yes

  No

  N/A

• Site location;

• Existing Speed Limit:

• Speed Limit Restricted to:

• TCP used?

  Yes

  No

  N/A

• RMS Autorisation #?

• TCP in place- date & time?

• TCP removed- date & time?

• Authorised by:

  Sign

• The following workers have been consulted and inducted to the site. Items requiring further consultation are added to the next Toolbox meeting.

• Name and signature of all workers onsite:

Signature

• Add signature

  Sign