Plant Risk Assessment Form

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Plant/Equipment Risk Assessment

NAME(S):
PLANT DESCRIPTION: Assessed by:
POSITION(S):
Assessment Area Supervisor:
RISK ASSESSMENT NO: Review Date: when circumstances, procedures
Date: &/or information change
Plant details (if relevant): *Associated / cross-reference documents (if relevant):
Location: Make/Model: HazChem RA(s) SWMS:
Serial #: Asset/EST Plant RA(s)
#:

Risk Risk Controls


Identified Hazards Risk Assessment Residual Risk implemented
Level Required Controls Level
Consequenc Consequenc Likellihood
Likellihood (see matrix ) (consider control hierarchy) (see matrix )
Hazard Class Hazard Description Prompts Comment / Specific Details e
?
e ? Yes No
? ?
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see physical prompt - - - -
Physical Selec Select
list Select- Select- Select- Select-
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see physical prompt - - - -
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list Select- Select- Select- Select-
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list Select- Select- Select- Select-
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see physical prompt - - - -
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list Select- Select- Select- Select-
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see physical prompt - - - -
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list Select- Select- Select- Select-
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see physical prompt - - - -
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list Select- Select- Select- Select-
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see physical prompt - - - -
Selec Select
list Select- Select- Select- Select-
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see environment - - - -
Environment Selec Select
prompt list Select- Select- Select- Select-
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see environment prompt - - - -
Selec Select
Select- Select- Select- Select-
list t- -

Plant Risk Assessment Form Revised 21 July 2014 Page 1


Plant/Equipment Risk Assessment
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see environment prompt - - - -
Selec Select
Select- Select- Select- Select-
list t- -
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see environment prompt - - - -
Selec Select
Select- Select- Select- Select-
list t- -
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see environment prompt - - - -
Selec Select
Select- Select- Select- Select-
list t- -
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see chemical prompt - - - -
Chemical Selec Select
list Select- Select- Select- Select-
t- -
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see chemical prompt - - - -
Selec Select
list Select- Select- Select- Select-
t- -
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see chemical prompt - - - -
Selec Select
list Select- Select- Select- Select-
t- -
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see biological prompt - - - -
Biological Selec Select
list Select- Select- Select- Select-
t- -
see biological prompt list - -
- - - -
Selec Select
Select- Select- Select- Select-
t- -
see biological prompt list - -
- - - -
Selec Select
Select- Select- Select- Select-
t- -
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see radiation prompt - - - -
Radiation Selec Select
list Select- Select- Select- Select-
t- -
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see radiation prompt - - - -
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list Select- Select- Select- Select-
t- -
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see ergonomic prompt - - - -
Ergonomic Selec Select
list Select- Select- Select- Select-
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see ergonomic prompt - - - -
Selec Select
list Select- Select- Select- Select-
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see training prompt - - - -
Training Selec Select
list Select- Select- Select- Select-
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Plant Risk Assessment Form Revised 21 July 2014 Page 2
Plant/Equipment Risk Assessment
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Other Selec Select
Select- Select- Select- Select-
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Plant Risk Assessment Form Revised 21 July 2014 Page 3


ADDITIONAL INFORMATION:
1. List any relevant Standards, Regulations, Codes of Practice, policies pertinent to the design and/or safe operation of this plant:

YES NO

2. Is this plant required to be registered under the Work Health and Safety Regulations?
If YES, is inspection and maintenance information available?
If further action is required, to be completed by: NAME: POSITION: DATE:

3. Is the operator of this plant/equipment required to be licenced, certificated or deemed competent?


If YES, is relevant documentation available?
If further action is required, to be completed by: NAME: POSITION: DATE:

4. Is an operation manual available for this plant/equipment?


If further action is required, to be completed by: NAME: POSITION: DATE:

5. *Have you identified any hazardous chemicals used with this plant/equipment? You must risk assess all associated hazardous
chemicals.
If YES, please enter document cross-reference details on page 1.
If further action is required, to be completed by: NAME: POSITION: DATE:

6. *Have Safe Work Method Statements been developed for this plant/equipment?
If YES, please enter document cross-reference details on page 1.
If further action is required, to be completed by: NAME: POSITION: DATE:

SUMMARY OF RISK:
Review the risk measured, and the controls, then please select the relevant risk summary statement:

A The assessment reveals that the potential risk to health from the use of the plant is not currently significant
B The assessment reveals that the potential risk to health from the use of the plant is significant, however controls are in place that reduce
risk to acceptable levels
C The assessment reveals that the potential risk to health from the use of the plant is significant. Interim controls are in place to reduce risk to
acceptable levels.

Approved by Area Supervisor:


signature date
REVIEW OF CONTROL MEASURES
Control measures are effective yes *no (*If no, you must do another Risk Assessment)

Date Reviewed: Signed:

Plant Risk Assessment Form Revised 21 July 2014


HOW TO ASSESS THE RISK

Step A - Consider the consequences Step B - Consider the likelihood Step C Calculate the Risk Level
For each hazard, consider the consequences if How likely is it that something will happen as a 1. Take the Step A rating and select the correct line
something happens. Consider what could result of the hazard? 2. Take the Step B rating and select the correct column
reasonably have happened, as well as what 3. Circle the risk level where the two ratings cross in the matrix below
actually happened (if there was an Look at the descriptions below and choose the
accident/incident). Look at the descriptions most suitable Likelihood Risk level =
below and choose the most suitable
consequence

Consequenc Description Likelihood Description Risk Matrix


e Likelihood
Fatality May cause death and/or Very likely Expected to occur in most Consequence
severe irreversible disability, circumstances Highly
Very likely Likely Possible Unlikely
unlikely
and/or permanent ill health
Major Severe injury or illness Likely Will probably occur in most Fatality Extreme High High High Medium
circumstances
Major injury High High High Medium Medium
Minor Minor (usually reversible) injury Possible Might occur occasionally
or illness resulting in days off Minor injury High Medium Medium Medium Medium
work
First Aid First aid level medical Unlikely Could happen at some time First aid Medium Medium Medium Low Low
treatment
Negligible No treatment required Highly May happen only in exceptional Negligible Medium Medium Low Low Low
unlikely circumstances

Prioritising Hazards Control Hierarchy


Pri Timeframe for Elimination Remove hazard
Risk Level orit Action implementation of corrective
y action Substitution Use a less hazardous alternative
The activity should cease immediately and Isolation Eg Restrict access, use in a closed container, fume cabinet
Extreme 1 short term safety controls implemented. Immediate
Notify manager and assess activity. Eg Trolleys to move loads, guards on machinery, Fume
Engineering
Implement short term safety measures cupboard
High 2 immediately. Within 24 hours Administration Eg: Training, Safe Work Method Statement, signage
Notify manager and assess activity. PPE - Personal
Implement short term safety controls. Eg: Gloves, respirator, safety glasses
Medium 3 Within 14 days Protective Equipment
Notify manager and assess activity.
Within 28 days (if possible) or
demonstrate that it is not
Implement long term safety controls.
Low 4 reasonably practicable to
Notify manager and assess activity.
achieve further minimization of
the risk

See WHS Risk Management Policy for further details


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