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Contractor Risk Assessment Form (PDF)

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					                                                                                                                                                         Contractor Risk Assessment Form
                                                                                                                            (May also be used as a Work Method Statement for a High Risk Construction Activity )
                                                                                                                                                                                                   Revision: 4
                                                                                                                                                                                            Date: 1 July 2008

    Contractor Details:
    Contractor Company Name:                                                                                                                           ABN:
    Company Address:
    Name of Key Contact Representative:                                                                                      Contact Details:

    Risk Assessment / Work Method Statement Details:
    PBC Site Contact:                                                                                           Work Site/Location:
    Work Activity Title:                                                                                                                                                         Date:
    Risk Assessment Personnel: (minimum 2 competent persons)
    Permit To Work Number: (if applicable)

 Task Tasks                                             Hazards                                  Controls                                               Responsible Party                          Risk Analysis*
  No. List in sequence,     the tasks involved in the   List the hazards relating to each task   For each identified hazard, list the controls to be    List the role, competency, prescribed      Controls In Place
          work activity – from pre-start preparation,   using the WHSQ Risk Management           implemented. They are to be based on the               occupation, etc. responsible for the
          through to work completion.                   Code of Practice 2007 as a guide as      hierarchy of controls and may include specific         controls (e.g. employee, supervisor,
                                                        required.                                control forms / work permits as required.              foreperson,      machine       operator,   L      C        R
                                                                                                                                                        electrician, scaffolder, etc).




*       Refer to the Workplace Health and Safety Queensland Risk Management Code of Practice 2007 as a guide as required, (L = Likelihood, C = Consequence, R = Risk).
Note: Although more than one page of the above may be required, the Monitoring, Approval & Communication sections must also be completed as part of the Risk Assessment development & implementation
      process.

Reference:
C:\Documents and Settings\axv\Objectivecache\Objects\A501084.doc                                                                                                                                            Page 1 of 2
                                                                                                                                          Contractor Risk Assessment Form
                                                                                                                 (May also be used as a Work Method Statement for a High Risk Construction Activity )
                                                                                                                                                                                        Revision: 4
                                                                                                                                                                                 Date: 1 July 2008


 Method for Monitoring / Reviewing Controls:
 Describe how the controls will be monitored and reviewed during the work activity, including reference to any inspections or checks and the responsible party/s who may undertake the monitoring.




 Risk Assessment Approval: (Contractor Supervisor / Manager)
 I have reviewed the above Risk Assessment content and approve the proposed work activity to commence once applicable communication has been undertaken with relevant persons.



           Approving Person’s Name (First & Last)                                          Signature                                            Date                                Time

 Risk Assessment Communication:
 The detail and requirements of the above Risk Assessment have been communicated to me and I fully understand the hazards and control measures to be implemented as part of this activity.

                                      Name                                                                        Signature                                                    Date




Reference:
C:\Documents and Settings\axv\Objectivecache\Objects\A501084.doc                                                                                                                           Page 2 of 2

				
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Description: Contractor Risk Assessment Form