Title Page

  • Conducted on

  • Prepared by

  • Location
  • Describe the Activity

  • Where is the activity taking place?

  • Who may be at risk by the activity

  • Identify the Hazards, Risks and Rate the Risk
    1) An activity may be divided into tasks. For each task identify the hazards and associated risks.
    2) List existing risk controls and determine a risk rating using the Hazard Identification, Risk Assessment and Control Procedure
    3) Additional risk controls may be required to achieve an acceptable level of risk. Re rate the risk if additional risk controls are used.

  • Task
  • What is the task being done?

  • What is the hazard identified for the task? (A hazard is a situation/action that has the potential to harm a person and/or the environment and/or damage property.)

  • What is the associated risk? (Risk is the resulting harm (injury, illness, damage) that may occur when exposed to a hazard.)

  • What are the existing risk controls?

  • Likelihood Definitions - Consider “If the hazard occurs, how likely is it that the worker will be injured?”. It is not how likely the hazard is to occur.

    Likelihood Definitions.png
  • Rate the Likelihood

  • Consequence Classifications - Consider “If a worker is exposed to this hazard, how bad would the most probable severe injury be?”

    Consequence Classification.png
  • Rate the Consequence

  • Risk Matrix

    Risk Matrix.png
  • What is the risk rating?

  • Priority of actions as determined by Risk Matrix. Low and Moderate are acceptable levels for work to continue. High and Very High levels are not.

    Risk Matrix Actions.png
  • Is the risk rating at a level that is acceptable - Low or Moderate?

  • What are the additional risk control to be implemented?

  • Risk Control
  • Briefly indicate why the risk control was implemented, when and by whom.

  • Rate the Likelihood

  • Rate the Consequence

  • What is the risk rating?

  • If the rating continues to remain at an unacceptable level. Stop all work and immediately notify your manager and the WHS Advisor.

  • Add signature

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