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									Annex B
OHS F 301-2006

 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

 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.

 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
                  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
                  required                   UNSW@ADFA local                           functionality
                  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
                  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

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