Plant Risk Assessment Template

• Conducted on

  Date

• Enter site name

• Prepared by

• Location
  Address

Plant Information

• Plant Item

• Plant Identification Details (Model/ Make/ Serial)

• Plant Owner Name

• Plant task description

• Is the plant designed to perform the task?

  Yes

  No

  N/A

• Is the plant in good working condition and free of weeds and mud?

  Yes

  No

  N/A

References

• Risk Matrix Reference

  

• Hierarchy of Controls Reference

  

Explosion/ Fire

• Can anyone be injured by an explosion of gas, vapours, liquids, dusts or other substances, triggered by plant operation?

  No

  Yes

  N/A

Hazard

• Activity

• Description of hazards identified

• Photo of hazard (optional)

  Media

• Persons at risk

Initial risk rating

• Initial consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Initial likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Initial risk rating

  High

  Medium

  Low

Residual risk rating

• Residual consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Residual likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Residual 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

• Enter other control measures

• Enter description of control measures

Electricity Contact

• Can anyone be injured by electrical shock or burnt due to damaged or poorly maintained leads, switches or equipment?

  No

  Yes

  N/A

Hazard

• Activity

• Description of hazards identified

• Photo of hazard (optional)

  Media

• Persons at risk

Initial risk rating

• Initial consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Initial likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Initial risk rating

  High

  Medium

  Low

Residual risk rating

• Residual consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Residual likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Residual 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

• Enter other control measures

• Enter description of control measures

Cutting

• Can anyone be cut, stabbed or punctured by coming in contact with moving plant or parts?

  No

  Yes

  N/A

Hazard

• Activity

• Description of hazards identified

• Photo of hazard (optional)

  Media

• Persons at risk

Initial risk rating

• Initial consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Initial likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Initial risk rating

  High

  Medium

  Low

Residual risk rating

• Residual consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Residual likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Residual 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

• Enter other control measures

• Enter description of control measures

Entanglement

• Can anyone’s hair, clothing, gloves, necktie, jewellery, rags and other materials become entangled with moving parts of plant, or materials in motion?

  No

  Yes

  N/A

Hazard

• Activity

• Description of hazards identified

• Photo of hazard (optional)

  Media

• Persons at risk

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

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

• Enter other control measures

• Enter description of control measures

Initial risk rating

• Initial consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Initial likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Initial risk rating

  High

  Medium

  Low

Residual risk rating

• Residual consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Residual likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Residual risk rating

  High

  Medium

  Low

Crushing

• Can anyone be crushed due to falling, uncontrolled or unexpected movement of plant or its load?

  No

  Yes

  N/A

Hazard

• Activity

• Description of hazards identified

• Photo of hazard (optional)

  Media

• Persons at risk

Initial risk rating

• Initial consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Initial likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Initial 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

• Enter other control measures

• Enter description of control measures

Residual risk rating

• Residual consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Residual likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Residual risk rating

  High

  Medium

  Low

Completion

• Recommendations

• Signature

  Sign