Information
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Client / Site
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Line / Equipment
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Assessment Conducted by
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Team Involved In Assessment
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Additional Team Members
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Conducted on
Purpose and Scope
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Provide brief context and extent of risk assessment
Methodology
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Documentation Review (notes & key findings)
(Includes previous risk assessments, incident trends, hazard registers, design reviews) -
Observations and Interviews with Operators (notes & key findings)
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Assessment
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Work Action, Load, repetition, duration
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Equipment (includes lifting, handling, moving equipment & tools)
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Environment (includes physical, workstation, noise, humidity, lighting, layout etc)
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Systems (includes procedures, roster, rotation, planning, fatigue)
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ADD RISKS
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Risk Factor Identified
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Risk likelihood ( how likely is it to occur)
- ALMOST CERTAIN (occur on a regular basis)
- LIKELY (Occur every 1-2 years)
- POSSIBLE (Occur every 2-5 years)
- UNLIKELY (Occurs every 5-10 years)
- RARE (Occur every 10 years)
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Potential Consequence (How severely could it harm a person or the environment?)
- INSIGNIFICANT (first aid)
- MINOR (referral to a medical practitioner)
- MODERATE (referral to medical practitioner and time off work)
- MAJOR (severe illness or injury requiring hospitalisation)
- CATASTROPHIC (fatality or significant disability)
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Risk Score
- EXTREME
- HIGH
- MEDIUM
- LOW
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Current controls in place
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Recommendation and responsible person.
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New Risk likelihood ( how likely is it to occur)
- ALMOST CERTAIN (occur on a regular basis)
- LIKELY (Occur every 1-2 years)
- POSSIBLE (Occur every 2-5 years)
- UNLIKELY (Occurs every 5-10 years)
- RARE (Occur every 10 years)
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New Potential Consequence (How severely could it harm a person or the environment?)
- INSIGNIFICANT (first aid)
- MINOR (referral to a medical practitioner)
- MODERATE (referral to medical practitioner and time off work)
- MAJOR (severe illness or injury requiring hospitalisation)
- CATASTROPHIC (fatality or significant disability)
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New Risk Score
- EXTREME
- HIGH
- MEDIUM
- LOW
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Control
- ELIMINATE
- Substitute
- ISOLATION
- Engineering Controls
- MINIMISE (Administration / PPE)
Signoffs
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