Title Page
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Location of the Workplace
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Prepared on
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Prepared by
Focus of the Workplace Risk Assessment
Goal of the Workplace Risk Assessment
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Why is this workplace risk assessment needed? (Other than being legally required)
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How could this workplace risk assessment help your business and your employees?
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What is the intended result, effect, or output of this workplace risk assessment?
Scope of the Workplace Risk Assessment
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What's included in this workplace risk assessment?
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What's not included in this workplace risk assessment?
Important Details Regarding the Workplace Risk Assessment
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Who will be involved in this workplace risk assessment and what level of responsibility or participation do they have?
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Where (specific room, site, facility, building, or area) will this workplace risk assessment be performed?
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When will this workplace risk assessment be performed?
Workplace Risk Assessment
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To begin the workplace risk assessment, select the "+" icon next to Hazard:
Hazard
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Description of hazard
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Photo of the hazard (optional)
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Who might be harmed?
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Risk related to hazard
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Risk likelihood
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Risk consequences
- Minor Injury or Illness
- Serious Injury or Illness
- Fatality, Major Injury or Illness
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Use this risk matrix to identify the risk level:
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Risk level
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Hazard causing risk can be eliminated?
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Are you already doing something to control this risk (existing risk control measure)?
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Develop a risk control measure targeting this risk.
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Briefly describe the existing control measure:
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Further action needed to control the risk?
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Select the "Action" icon to create an action, assign it to someone, and set a due date.
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Eliminate the hazard causing the risk.
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Are you already doing something to control this risk (existing risk control measure)?
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Briefly describe the existing control measure:
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Further action needed to control the risk?
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Select the "Action" icon to create an action, assign it to someone, and set a due date.
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Further action needed to control the risk?
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Select the "Action" icon to create an action, assign it to someone, and set a due date.
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Monitor this risk.
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To ADD another hazard to the workplace risk assessment, select the "+" icon next to Hazard.
To END the workplace risk assessment, select the "Next Page >" button at the bottom right.
Completion/Review
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What risk control measures have you developed?
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How will you monitor the effectiveness of these risk control measures?
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How often will you review this workplace risk assessment?
- Every 2 weeks
- Every month
- Every 3 months
- Every 6 months
- Every year
- Every 15 months
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The HSE recommends reviewing workplace risk assessments at least annually.
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Name and Signature of Employer/Owner/Manager of Workplace
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Did the employer/owner/manager of the workplace perform the workplace risk assessment himself/herself?
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Name and Signature of Appointed Person