Risk Assessment Template
Risk Assessment Team (include name and position): / Date: / /
1. / 5.
2. / / 6.
3. / 7.
4. / / 8

Location

School//Work Area

Describe the task being assessed:

Please tick:

ElectricalPlant/Equipment

Fall from HeightManual Handling

NoiseRadiation

TrafficChemicals

Mists/Dusts/FumesLasers

TemperatureBiological

Pressure/Vibration

Psychological

Confined Spaces

Lighting

Slips/trips

Risk Assessment(rate the consequence, exposure and probability associated with each hazard identified):

FACTOR

/ CLASSIFICATION /

RATING

1. CONSEQUENCE

Most probable result of the potential accident. / Catastrophe (multiple fatalities)(Immediately contact your Senior H&S Advisor) / 100
Disaster (fatality)(Immediately contact your Senior H&S Advisor) / 50
Very serious (permanent disability/ill health) / 25
Serious (serious injury/admission to hospital / Lost Time Injury –LTI) / 15
Important (medical attention needed/moderate injury) / 5
Noticeable (minor cuts, bruises or sickness/near miss) / 1
2. EXPOSURE
The frequency of exposure to the hazard. / Continuously (or many times daily) / 10
Frequently (approximately once daily) / 6
Occasionally (from once per week to once per month) / 3
Infrequent (from once per month to once per year) / 2
Rarely (it has been known to occur) / 1
Very rarely (not known to have occurred) / 0.5
3. PROBABILITY
Likelihood that the consequence will occur once the individual is exposed to the hazard. / Almost certain (the most likely outcome if the event occurs) / 10
Likely (usual, perhaps 50-50 chance) / 6
Unusual but possible (eg. 1 in 10) / 3
Remotely possible (eg. 1 in 100) / 1
Conceivable (has never happened in years of exposure, but possible, eg. 1 in 1,000) / 0.5
Practically impossible (no knowledge or ever having occurred anywhere, eg 1 in 10,000) / 0.1
CONSEQUENCE / X / EXPOSURE / X / PROBABILITY / = / RISK SCORE
Risk Score:
RISK SCORE / DEFINITION / ACTION
>500 / Very high risk (VH) / Activity to cease/make safe immediately
300- 499 / High risk (H) / Activity to cease/make safe immediately
100- 299 / Substantial risk (S) / Implement controls to reduce risk. Supervisor sign off for activity to continue.
50- 99 / Moderate risk (M) / Implement controls to reduce risk. Supervisor sign off for activity to continue.
10- 49 / Low risk (L) / Review annually.

Continuously implement controls to get risk as low as possible

Step by step description of task / Hazard(s) identified* / Consequence rating / X / Exposure rating / X / Probability rating / = / Risk Score/Definition
1 / X / X / =
2 / X / X / =
3 / X / X / =
4 / X / X / =
5 / X / X / =
6 / X / X / =
7 / X / X / =
8 / X / X / =
9 / X / X / =
10 / X / X / =
11 / X / X / =
12 / X / X / =
13 / X / X / =
14 / X / X / =
15 / X / X / =
16 / X / X / =
17 / X / X / =
18 / X / X / =
19 / X / X / =
20 / X / X / =
21 / X / X / =
22 / X / X / =
23 / X / X / =
24 / X / X / =

Risk Control:to determine appropriate risk control measures(s) sequentially go through the hierarchy of controls, the higher up in the hierarchy, the more effective the control, (ie Elimination is the most effective and Personal Protection the least effective). Please refer to the ‘Hierarchy of Controls’ Instruction for further information.

Hierarchy of Risk Controls

1. Eliminate
Is it possible to eliminate the hazard?

2. Reduce
Is it possible to reduce the level of risk posed by the hazard by (priority order):
  • Substitution (using less hazardous alternatives)
  • Isolation (separating the operator from the risk)
  • Engineering controls (re-designing plant or equipment).

3. Administration
Is it possible to reduce the level of risk posed by the hazard by changing operating procedures, training, supervision, providing information etc
4. Personal Protection
Is it possible to reduce the level or risk posed by the hazard by wearing personal protective equipment and clothing?

Risk Control Action Plan

Number
Step in task / Hazard(s) identified / Recommended Risk Controls to be Implemented
Eliminate Reduce Admin PPE / Person Responsible / Due date / Completed
(date) / Original Risk Score / Residual risk score
(rescore once risk control measures are implemented)

Manager:HSR:

Employees:

Author Health, Safety & Wellbeing Team

Version: 001

Date: Nov 2014Page 1 of 7

Printed Copies are Uncontrolled