Plant Risk Assessment Template

• Site name

• Conducted on

  Date

• 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

Suffocation

• Can anyone be suffocated due to lack of oxygen or atmospheric contamination?

  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

Pressurized Content

• Can anyone be injured by fluids or gases under high pressure due to plant failure or misuse?

  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

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

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

Slips, Trips, Falls

• Can anyone slip, trip, or fall due to:<br>• uneven, slippery, or steep surfaces, <br>• obstacles or poor housekeeping<br>• ladders, stairs, platforms, or lack of guardrails

  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

Ergonomics

• Can anyone be injured due to poorly designed work area, repetitive body movement, poor light placing, or other ergonomic issues?

  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

Radiation

• Can anyone in the plant's vicinity suffer injury or illness due to exposure to radiation in the form of infra-red, ultra violet light, or microwaves?

  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

Noise

• Can anyone in the plant's vicinity suffer injury or illness due to exposure to noise?

  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

Vibration

• Can anyone in the plant's vicinity suffer injury or ill-health due to exposure to vibration?

  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

Temperature/Moisture

• Can anyone be injured or suffer ill-health due to exposure to:<br>• high or low temperatures<br>• objects of high or low temperatures<br>• moisture

  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

Other Risks

• Other risks that can cause injury or ill-health?

  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

Completion

• Recommendations

• Name and Signature

  Sign