Risk assessment form - DOC by Caesura

VIEWS: 35 PAGES: 5

									Business Name _______________________________________
Risk Assessment completed by: ___________________________________

Division: Document number Initial Issue date

Section/Unit: Current version Current Version Issue date Next review date

For additional information refer to the publication 6 Steps to Risk Management or the ACT OHS Commissioner’s website – www.worksafety.act.gov.au .

Risk Assessment title:

Step 1: Identify the activity
Describe the activity:

Describe the location where the activity occurs:

Step 2: Identify who may be at risk by the activity
A number of people may be at risk from any activity. This may affect the risk controls needed. These people may include fellow workers, visitors, contractors and the public. The location of the activity may affect the number of people at risk.

Steps 3 to 7: Identify the hazards, risks, and rate the risks
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 Risk Rating Table on page 4. 3. Additional risk controls may be required to achieve an acceptable level of risk. Re-rate the risk if additional risk controls used. Risk rating with existing controls * Tasks Hazards (Step 3) Associated risks (Step 4) Existing risk controls I (Step 5) L R Additional risk controls required (Step 6) (Apply the hierarchy of risk controls) Risk Rating with additional controls * (Step 7) I L R

* I = impact or consequence

L = likelihood R = risk rating

from the Risk Rating Table (page 4)

Step 8 Documentation and supervisor approval
Completed by: (name) (signature) Authorised by: (name) (signature) Date:

Step 9: Implement the additional risk controls identified
Indicate briefly what additional risk controls from Step 6 above were implemented, when and by whom. Risk control: Risk control: Risk control: Risk control: Risk control: Date: Date: Date: Date: Date: Implemented by: Implemented by: Implemented by: Implemented by: Implemented by:

Step 10: Monitor and review the risk controls
It is important to monitor risk controls and review risk assessments regularly. Review is required when there is a change in the process, relevant legal changes, and where a cause for concern has arisen. Reviews could be scheduled on an annual basis. If the risk assessment has substantially changed a new risk assessment is warranted. Review date: Review date: Review date: Review date: Review date: Reviewed by: Reviewed by: Reviewed by: Reviewed by: Reviewed by: Authorised by: Authorised by: Authorised by: Authorised by: Authorised by:

Documentation
It is a important that any legal and advisory documentation that supports this risk assessment be listed. Regulations, Australian Standards and Codes of Practice, where applicable. Such documentation includes Acts,

IMPACT:
Catastrophic Major Moderate Minor Insignificant

How severely could someone be hurt death or permanent disability to one or more persons hospital admission required medical treatment required first aid required injuries not requiring first aid How likely are those consequences? expected to occur in most circumstances will probably occur in most circumstances could occur at some time is not likely to occur in normal circumstances may occur only in exceptional circumstances

LIKELIHOOD:
Almost certain Likely Possible Unlikely Rare

LIKELIHOOD Rare 1 M L L L VL Unlikely 2 M M M L VL Possible 3 H M M M L Likely 4 C H M M L Almost Certain 5 C C H M M

IMPACT Catastrophi c A Major B Moderate C Minor D Insignifica nt E

_______________________________________________________________________________________________________ ________ Page 4 of 5 ACT OHS Commissioner OHS Risk Rating Table Effective date: 07/04/2009 Current Version: 1.0,07/04/2009

_______________________________________________________________________________________________________ ________ Page 5 of 5 ACT OHS Commissioner OHS Risk Rating Table Effective date: 07/04/2009 Current Version: 1.0,07/04/2009


								
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