Annex B OHS F 301-2006 RISK ASSESSMENT FORM A NB: For information on completing the risk assessment refer to the UNSW@ADFA OHS Risk Management Risk Assessment Record No: (check Procedure http://www.unsw.adfa.edu.au/admin/ohs/policies/ohs_risk_management_proc_0606.pdf local requirements) 1. Task/Project Task/Project: Task/Project Record No.: Task/Project Leader(s): Commencement Date: Task or equipment description: Completion Date: New Task / Existing Task (circle one) If existing task, reassessment because of: Location of work (eg: sites, buildings, rooms): New equipment / procedure Identification of previously unidentified hazard: List any special equipment/facility requirements: 2. Possible Hazards (Please tick boxes; include hazards to staff, students, visitors and passers-by) Materials & Substances Equipment / Energy Sources Work Environment Biomechanics / Manual Handling Work Organisation Chemicals: Use form C Electrical Lighting Posture Work Space Ionising Radiation: Use form B Thermal Noise/ Vibration Load Factors (shape, size) Assistance available Biological Mechanical Dust / Fumes/Vapours Repetition Time Constraints Lasers Kinetic Access/Egress Distance Supervision Microwaves Pneumatic Confined spaces Keyboard Interactions public/contractors) Waste Hydraulic Climate Duration After hours Electrical Rotational Housekeeping Lab. instruments Inadequate rest breaks Infrared Mechanical aids Work at height Individual Factors Other: (Specify) Water Acoustic Animals/insects New Employee Ultraviolet (outdoor exposure) Pressure/Vacuum Visually demanding Lone worker Electromagnetic field Equipment licenses Flooring (Slips, trips) Training required Non-ionising radiation Operator Licenses Isolation OHS F301-2006 Risk Assessment Form A Uncontrolled document when printed Current Version: V2.02/08 OHS F 301-2006 - Risk Assessment Form A 3. Risk Analysis ACTIVITY / TASK HAZARD RISK CONTROLS refer section 4 Risk Rating (after controls in place) Describe steps/ Details of hazards What can happen? List all controls using the hierarchy of controls – Consequence Likelihood Rating activities identified How can it happen? intended to support the development of safe (section 7) (section 8) (Section 9) systems of work 4. HIERARCHY OF RISK CONTROLS: The order for implementing risk control measures with the most desirable being hazard elimination, the least desirable being the provision of PPE a. Elimination - remove the hazard completely during design or later; b. Substitution - replace with a less hazardous substance/ activity / process; c. Isolation / Engineering – measures to reduce exposure e.g. install guards on machinery, fume extraction, remote controls, automation, etc; d. Administration - signs and procedures for safe practices, training, supervision, etc; e. Personal protective equipment (PPE) - respirators, ear plugs, gloves, etc. 5. HAZARD ASSESSMENT COMPLETED: Signature: Name: Date: / / RECOMMENDED REVIEW DATE: 1. Date: / / 2. Date: / / 6. APPROVAL (if required based upon local procedures) Supervisor/ Research Leader Signature: Name: Date: / / Other (Head of School etc) (if required) Signature: Name: Date: / / OHS F301-2006 Risk Assessment Form A Uncontrolled document when printed Current Version: V2.02/08 Annex B: Hazard Identification/Risk Assessment Worksheet Part A 7. Table 1 Consequence Level Health and Safety Natural Environment Functionality Financial Descriptor Descriptor Descriptor Loss Indicator Minor injuries only; Minor spill or leak of hazardous Temporary damage a $0 - First Aid treatment materials with potential effects in localised UNSW@ADFA $9,999 MINOR required UNSW@ADFA local functionality facility/laboratory Injuries which could Large spill or gas leak requiring Temporary damage to $10,000- result in temporary Emergency Services response to UNSW@ADFA $24,999 MODERATE disability; Medical prevent harmful effects at functionality treatment required UNSW@ADFA Serious injuries that Acute environmental impact Temporary loss or severe $25,000- could result in outside UNSW@ADFA campus damage to UNSW@ADFA $200,000 MAJOR permanent disability; with potential short term functionality Hospitalisation environmental effect admission required Death or permanent Severe environmental impact. Long-term damage to $200,000 SEVERE disability to 1-2 Potential serious long term harm to UNSW@ADFA - $1M persons ecosystem functionality CATASTRO- Several fatalities Irreversible and extensive damage Indefinite loss of >$1M PHIC caused to matter of National UNSW@ADFA environmental significance functionality 8. Table 2 Likelihood Level Descriptor Description Indicative Frequency Almost certain The event is expected to during the activity under consideration During the next year Likely Could occur during the activity under consideration Once every year to three years Possible The event might occur at some time. Once every 10 years Unlikely The event is not likely to occur in normal circumstances. Once every 30 years Rare The event may occur only in exceptional circumstances Once every 100 years 9. Table 3 Overall Risk Rating Likelihood Consequences level level Minor Moderate Major Severe Catastrophic Almost certain Medium Medium High Very High Very High Likely Medium Medium High Very High Very High Possible Low Medium Medium High Very High Unlikely Low Low Medium Medium High Rare Low Low Low Low Medium 10. Table 4 Acceptability and Implications Risk Level Acceptability Implications Very High Intolerable If the risk rating is “Very high”, then the activity should not proceed. An alternative safer method of work is required or additional controls based on the hierarchy of controls must be implemented to reduce the likelihood and/or consequence. High Tolerable with If the risk rating is “High”, review the risk controls and add additional controls to continuous reduce the risk level. A well documented system of work including standard review operating procedures, training, monitoring and supervision is required. Continued exposure would only be considered in exceptional circumstances, and the decision to do so should be made at senior levels, after due consideration of the cost versus benefit. Any decision to continue the exposure to the risk must be subject to continuous review. Medium Tolerable with Exposure to the risk may continue provided it has been appropriately assessed, has periodic review been mitigated to As Low As Reasonably Practicable (ALARP), and is subject to periodic review to ensure the risk does not increase. It would be appropriate that measures to achieve long term further reduction to the risk be considered. Low Acceptable with Exposure to the risk is acceptable with periodic review to ensure the risk does not periodic review increase. OHS F301-2006 Risk Assessment Form A Uncontrolled document when printed Current Version: V2.02/08
"RISK ASSESSMENT FORM A"