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Risk Assessment & Control Form - July 2013
Risk Assessment & Control Form - July 2013
Anonymous

Risk Assessment & Control Form - July 2013

WHS Manual 2.1.1

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Free Risk Assessment & Control Form - July 2013 Checklist

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Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

  • 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)

  • Add media

  • Risk Matrix Ready Reackoner

    no label

  • Likelihood

  • Consequence

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • 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?

  • What is the likelihood of the hazard occurring?

Details of recommended controls

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

  • Risk Matrix Ready Reackoner

    no label

  • Overall Score

    • High (1A)
    • High (2A)
    • High (2B)
    • High (3B)
    • High (3C)
    • High (4D)
    • High (5E)
    • Extreme (3A)
    • Extreme (4A)
    • Extreme (4B)
    • Extreme (4C)
    • Extreme (5A)
    • Extreme (5B)
    • Extreme (5C)
    • Extreme (5D)
    • Medium (1B)
    • Medium (2C)
    • Medium (3D)
    • Medium (3E)
    • Medium (4E)
    • Low (1C)
    • Low (1D)
    • Low (1E)
    • Low (2D)
    • Low (2E)

Implementation plan

  • Action Required:

  • By Whom:

  • By When:

  • Date Completed:

  • Action Required:

  • By Whom:

  • By When:

  • Date Completed:

  • Action Required:

  • By Whom:

  • By When:

  • Date Completed:

  • Action Required:

  • By Whom:

  • By When:

  • Date Completed:

  • Action Required:

  • By Whom:

  • By When:

  • Date Completed:

  • Action Required:

  • By Whom:

  • By When:

  • Date Completed:

  • Action Required:

  • By Whom:

  • By When:

  • Date Completed:

Sign off/close out

  • Risk Assessment conducted by?

  • Risk Assessment conducted by?

  • Risk Assessment conducted by?

  • Risk Assessment conducted by?

Manager review

  • Add signature

Risk Assessment & Control Form - July 2013
Anonymous

Risk Assessment & Control Form - July 2013

WHS Manual 2.1.1

Use this Template
The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.

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