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Risk Assessment Form1

The document provides a general risk assessment procedure and template for managing workplace health and safety risks. It involves forming an assessment team, identifying hazards, rating risks, determining required controls, and developing an implementation plan. Hazards are grouped into categories like general work environment, health and security, plant and equipment.

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Elites Chorale
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0% found this document useful (0 votes)
122 views3 pages

Risk Assessment Form1

The document provides a general risk assessment procedure and template for managing workplace health and safety risks. It involves forming an assessment team, identifying hazards, rating risks, determining required controls, and developing an implementation plan. Hazards are grouped into categories like general work environment, health and security, plant and equipment.

Uploaded by

Elites Chorale
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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GENERAL RISK ASSESSMENT

Managing Workplace Health and Safety Risks procedure

Workplace Visited (Company/Organisation/Institute/Unit):

Name of Assessor: Assessment Date: / / Review Date: / /

What is being assessed? Describe the item, job, process, work arrangement:
_________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

Step 1 - Form a team of assessors. Decide who else should be consulted.


Assessor(s):

Others consulted: (eg elected health and safety representative, other personnel exposed to risks)

Step 2 - Identify the hazards associated with the thing or situation being assessed
Hazards: Potential to cause harm to people, property or the environment. Tick the applicable hazards
General Work Environment Health and Security Plant and equipment
Restricted access or egress Food Vehicles

Confined spaces Poisoning or contamination Mobile and fixed plant

Air-conditioning (thermal comfort) Intoxication Powered equipment

Air quality Dehydration Non-powered equipment

Lighting Violence Elevated Work Platforms

Noise (discomfort) Working alone or in isolation Pressure vessel

Outdoors (sun exposure) Working in remote areas Laser (Class 2 or above)

Uneven walking surfaces Bites / Stings Traffic control

Working at height Electrical

Chemical Vibration

Ergonomic/manual handling Hazardous chemicals Moving parts

Workstation set up Explosives Acoustic / Noise

Poor posture Engineered nanomaterials

Lifting / Carrying Gas cylinders Temperature / Weather effects

Pushing / Pulling Heat

Reaching/overstretching Radiation Cold

Repetitive movement Ionising radiation Rain / Flood

Bending Ultraviolet (UV) radiation Wind

Eye strain Radiofrequency/microwave In or on water

Infrared radiation Pressure (Diving / Altitude)

Work design and management Lightning

Fatigue Biological Smoke

Workload Microbiological

Mental stress Animal tissue / Fluids OTHER

Organisational change Human tissue / Fluids

Work violence or bullying Allergenic

Inexperienced or new personnel Other Biological

List the hazards identified from above


1. 6.
2. 7.
3. 8.
4. 9.
5. 10.
Any specific circumstances (describe):
     
Persons at risk (list):
     
Any relevant regulation, code, standard or guideline (list):
     
Step 3 – Risk Assessment For each identified hazard rate the risk using the Risk Rating Matrix.
Step 4 – Risk controls Detail controls measures required to address the risks applying the Hierarchy of Controls
Details of suggested time frame found in risk assessment matrix
Controls to be considered from the following hierarchy of control
1. Elimination (is it necessary?) 5. Administration (training. SOPs,)
2. Substitution 6. Personal Protective Equipment (PPE) (eg
3. Isolation (restrict access) gloves, leather apron, coveralls, respirator)
4. Engineering (guarding, redesign)
Identified Hazards Risk assessment Risk Required Controls Suggested Time
Frame
Exposure Consequences Likelihood Rating

Is the risk? Adequately controlled. No further action required - Sign off form as completed.
(Tick one) Inadequately controlled. Further Action/Investigation required. Continue with Step 5.
Step 5 – Implementation Plan (for controls not already in place)
Control Option Resources Person(s) responsible Proposed
implementation
date

Step 6 – Comments and endorsements


     

Name:       Signature:       Date:      


Assessment Approval: (eg Principal researcher, Head of research group, Technical Services Manager)
I am satisfied that the risks are not significant and/or adequately controlled and that resources required will be provided.

Name:       Signature:       Date:      

Position Title:      


Risk Assessment Matrix

Novelle Center ® General Risk Assessment, V1.1 January 2013 Safety and Wellbeing Unit Page 2 of 3
PRIORITISING HAZARDS AND RISKS

C Probability
o
n Very Likely Likely Unlikely Highly Unlikely
s
e Life Threatening High High High Medium
q
u Detrimental High High Medium Medium
e
n Harmful High Medium Medium Low
c
e Negligible Medium Medium Low Low

HAZARD CONSEQUENCE RATING TABLE

Life Threatening Hazard may cause death or total loss of one or more bodily functions (eg. loss of: or use an
arm, an eye, huge financial loss).
Detrimental Hazard may cause severe injury, illness or permanent partial loss of one or more bodily
functions (eg. noise induced hearing loss), or serious property damage, loss of production
capability.
Harmful Hazard may cause a reportable incident ie. an incident that results in the employee being
unable to undertake their normal duties for 7 days or more, or significant property damage,
high financial loss.
Negligible Hazard may cause minor injury, illness or property damage, first aid treatment only or no
injury, low financial loss.

PROBABILITY RATING TABLE

Very Likely Exposure to hazard likely to occur frequently.


Likely Exposure to hazard likely to occur but not frequently.
Unlikely Exposure to hazard unlikely to occur.
Highly Unlikely Exposure to hazard so unlikely that it can be assumed that it will not happen.

RISK PRIORITY TABLE

Risk Priority Definitions Of Priority Suggested Time


Frame
High Situation critical, stop work immediately or consider cessation of work process. Now
Must be fixed today, consider short term and/or long term actions.
Medium Is very important, must be fixed this week, consider short term and/or long term This Week
actions.
Low Is still important but can be dealt with through scheduled maintenance or 1 - 3 Months
similar type programming. However, if solution is quick and easy then fix it
today.
Review and/or manage by routine procedures.

Novelle Center ® General Risk Assessment, V1.1 January 2013 Safety and Wellbeing Unit Page 3 of 3

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