Risk Assessment & Control Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Hazards considered

• Unexpected movement of plant/machinery

• Being struck by moving parts

• Falling from height

• Sharp tools or components

• Mobile equipment

• Collapse of infrastructure

• Exposure to dust/fumes/vapours/noise

• Exposure to extreme hot or cold

• Fluids under pressure

• Contact with live electrical conductors

• Missing/removed Guarding and safety devices

• Slips, trips and falls

• Injury from manual handling

• Using the wrong tools for the job

• Poor housekeeping, disposal of waste

Hazard Information

• Describe the hazard (include photos)

• Likely hood

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• Consequence

  Insignificant

  Minor

  Moderate

  Major

  Catastrophic

• How could the incident occur?

• What is the most likely consequence if an incident occurs?

• Who is exposed to the hazard?

• How frequently are personal exposed to the hazard?

• Frequency Rate

  Frequently

  Often

  Occasional

  Rarely

  Never

• What is the likelihood of the hazard occurring?

• Likely hood

  Almost Certain

  Likely

  Possible

  Unlikely

  Rare

Details of recommended controls

• Control

• Control

• Control

• Control

• Control

• Control

• Almost Certain

  Likely

  Possible

  Unlikely

  Rare

• Insignificant

  Minor

  Moderate

  Major

  Catastrophic

Implementation plan

• Action Required

• Person Responsible

• Action Due Date

  Date

• Action Required

• Person Responsible

• Action Due Date

  Date

• Action Required

• Person Responsible

• Action Due Date

  Date

• Action Required

• Person Responsible

• Action Due Date

  Date

• Action Required

• Person Responsible

• Action Due Date

  Date

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• Risk Assessment conducted by?

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• Risk Assessment conducted by?

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• Risk Assessment conducted by?

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• Risk Assessment conducted by?

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• Risk Assessment conducted by?

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Manager review

• Add signature

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