Plant Risk Assessment Form

• Document No.

• Risk Assessment number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Assessment Summary

• Assessment Title (Plant Description)

• Plant ID No.

• Licence/Registration number

• Has plant been entered into asset register?

  Yes

  No

  N/A

• Make

• Model

• Serial Number

• Site:

• Concept

• New/initial/commissioning

• Alteration

• Re-location

• Revised assessment

• Department:

• Construction

• Town Maintenance

• Location:

• Loxton

• Waikerie

• Plant/Project No:

• Date of purchase

  Date

• Used for

• Used by

• Incident history (incident numbers):

Risk Assessment Team

• 1. Name

• Position

• Waikerie Works Manager

• Loxton Works Manager

• Loxton Town Maintenance Team Coordinator

• Loxton Construction Team Coordinator

• Waikerie Works Manager

• Waikerie Town Maintenance Team Coordinator

• Signature

  Sign

• Date

  Date

• 2. Name

• Position

• Loxton Works Manager

• Loxton Town Maintenance Team Coordinator

• Loxton Construction Team Coordinator

• Waikerie Works Manager

• Waikerie Town Maintenance Team Coordinator

• Signature

  Sign

• Date

  Date

• 3. Name

• Position

• Loxton Works Manager

• Loxton Town Maintenance Team Coordinator

• Loxton Construction Team Coordinator

• Waikerie Works Manager

• Waikerie Town Maintenance Team Coordinator

• Signature

  Sign

• Date

  Date

• 4. Name

• Position

• Loxton Works Manager

• Loxton Town Maintenance Team Coordinator

• Loxton Construction Team Coordinator

• Waikerie Works Manager

• Waikerie Town Maintenance Team Coordinator

• Signature

  Sign

• Date

  Date

Department Manager/Supervisor

• Name

• Signature

  Sign

• Date

  Date

OHS Rep, Team Leader or Operator

• Name

• Signature

  Sign

• Date

  Date

OHS/Risk Coordinator

• Name

• Signature

  Sign

• Date

  Date

Training

• Is a Licence or Training needed to operate this plant?

  Yes

  No

  N/A

• Details:

• Is a Trade Certificate needed to operate this plant?

  Yes

  No

  N/A

• Details:

• Is there a SOP associated with this plant?

  Yes

  No

  N/A

• Details:

• Is there an Induction procedure associated with this plant?

  Yes

  No

  N/A

• Details:

• List of related Standards, ACOP's, SOP's, Operating manuals, Documents.

Hazards, Controls & Improvements

• Risk Matrix

  

A. Entanglement- Due to...

• A1 Can anyone's hair, clothing, gloves, jewellery, cleaning materials become entangled in moving or spinning parts?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• A2 Can someone/something become crushed between objects?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• A3 Can someone/something get Cuts, Stabbed, Abrasions or Puncture wounds from using this plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• A4 Can someone/something become amputated from using this plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• A5 Can someone/something become injured due to friction while using this plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• A6 Other (specify)?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

B. Crushing- Due to...

• B1 Material falling off the plant

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• B2 Uncontrolled or unexpected movement of the plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• B3 Lack of capacity of the plant to be slowed, stopped or imobilised?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• B4 The plant tipping or rolling over?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• B5 Parts of the plant collapsing?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• B6 Coming into contact with moving parts during testing, inspection, operation, maintenance, cleaning or repair?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemen

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• B7 Being thrown off or under the plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• B8 Other (Specify)?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

C. Cutting, Stabbing & Puncturing- Due to...

• C1 Coming into contact with sharp or flying objects?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• C2 Coming into contact with moving parts of plant during testing, inspection, maintenance, cleaning or repair of the plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• C3 The plant or work pieces disintegrating?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• C4 Work pieces or plant pieces being ejected?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• C5 The mobility of the plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• C6 Uncontrolled or unexpected start-up or movement of the plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• C7 Other (specify)?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

D. Shearing- Due to..

• D1 Body parts being sheared between two parts of the plant or parts of the plant and a work piece or structure?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

E. Friction Burn- Due to...

• E1 Contact with friction heated moving parts/surfaces of plant or materials?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

F. Striking by Moving Objects- Due to...

• F1 Uncontrolled or unexpected movement of the plant or materials?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• F2 The plant, parts or works pieces disintegrating?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• F3 Work pieces being ejected?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• F4 Mobility or movement of the plant or plant parts?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• F5 Other (specify)?

  Yes

  No

  N/A

• Details:

• Existing control measures in place?

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

G. High Pressure Fluid Injury- Due to...

• G1 Coming into contact with fluids under high pressure due to plant or hose failure or misuse of the plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

H. Suffocation- Due to...

• H1 Lack of oxygen or atmospheric contamination?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

I. High Temperature Injury- Due to...

• I1 Coming into contact with objects at high temperatures?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• I2 Fire?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

J. Thermal Discomfort- Due to...

• J1 Exposure to high or low temperatures?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

K. Electrical Shock or Electrical Burn- Due to...

• K1 The plant contacting live electrical conductors?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• K2 The plant working in close proximity to electrical conductors?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• K3 Overload of electrical circuits?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• K4 Damaged or worn electrical cables, leads or switches?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• K5 Water near electrical equipment?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• K6 Inadequate isolation of electrical power supply?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• K7 Residual electrical energy?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

L. Explosion- Due to...

• L1 Explosion of flammable or explosive gases, vapours, liquids, dust or other substances triggered by operation of the plant or material?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• L2 High pressure build up?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

M. Slipping, Tripping or Falling- Due to...

• M1 Uneven or slippery surfaces?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• M2 Poor housekeeping, e.g. equipment, etc. not stored properly?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• M3 Obstacles being placed in the vicinity of the plant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• M4 Other (specify)?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

N. Falling from Height- Due to...

• N1 Lack of a proper work platform?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• N2 Lack of proper stairs or ladder?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• N3 Lack of guardrails or suitable edge protection?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• N4 Unprotected holes, penetrations or gaps?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• N5 Poor floor or walking surfaces, not slip resistant?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• N6 Steep or sloping walking surfaces?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• N7 Collapse of the supporting structure?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• N8 Other (specify)?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

O. Ergonomics or Plant Environment Injury- Due to...

• O1 Poorly designed seating?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• O2 Repetitive body movements?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• O3 Constrained body posture or the need for excessive effort?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• O4 Design deficiency causing mental or psychological stress?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• O5 Inadequate or poorly placed lighting?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• O6 Lack of consideration given to human error or human behaviour?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• O7 Mismatch of the plant with human traits and natural limitations?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• O8 Other (specify)?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

P. Other Hazards- Injuries or ill health due to...

• P1 Chemicals?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• P2 Dust?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• P3 Radiation?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• P4 Toxic gases?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• P5 Noise?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Select Low Medium High Extreme

  • Low
  • Medium
  • High
  • Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• P6 Fumes?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

• P7 Vibration?

  Yes

  No

  N/A

• Details:

• Existing control measures in place:

• Risk rating before controls

  Low

  Medium

  High

  Extreme

• Improvements needed to ensure safety:

• Risk Score after controls implemented:

  Low

  Medium

  High

  Extreme

• Is this an acceptable level of risk?

  Yes

  No

  N/A

• Why?

Recommended Improvements

• Description of improvement, person responsible, timeframe, date of completion & signed off.

- Improvement

• Description of improvement:

• Person responsible:

• Date to be completed by:

  Date

• Actual date of completion:

  Date

• Name of person completing improvement:

  Sign

Photos/drawings of Plant

• Photos of plant:

- Photo

• Description of photo:

  Media

• Drawing(s) of plant:

- Drawing

• Description of drawing

  Drawing