Business Name _______________________________________
Work Safety Risk Assessment completed by: ___________________________________
Risk Assessment
& Control Form
Division: Section/Unit:
Document number Initial Issue date Current version Current Version Next review date
Issue date
For additional information refer to the publication 6 Steps to Risk Management or the ACT OHS Commissioner’s website – [Link] .
Risk Assessment title:
Step 1: Identify the activity
Describe the activity:
Describe the location where the activity occurs:
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Risk Assessment and Control Form Date Effective: 07/04/2009
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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 Additional risk Risk Rating with
existing controls additional
controls * required controls *
Hazards Associated risks
Tasks Existing risk controls
(Step 5) (Step 6) (Step 7)
(Step 3) (Step 4)
I L R (Apply the hierarchy I L R
of risk controls)
* I = impact or consequence L = likelihood R = risk rating from the Risk Rating Table (page 4)
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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: Date: Implemented by:
Risk control: Date: Implemented by:
Risk control: Date: Implemented by:
Risk control: Date: Implemented by:
Risk control: Date: 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: Reviewed by: Authorised by:
Review date: Reviewed by: Authorised by:
Review date: Reviewed by: Authorised by:
Review date: Reviewed by: Authorised by:
Review date: Reviewed by: Authorised by:
Documentation
It is a important that any legal and advisory documentation that supports this risk assessment be listed. Such documentation includes Acts, Regulations, Australian Standards
and Codes of Practice, where applicable.
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Risk Assessment and Control Form Date Effective: 07/04/2009
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ACT OHS Commissioner OHS Risk Rating Table
IMPACT: How severely could someone be hurt
Catastrophic death or permanent disability to one or more persons
Major hospital admission required
Moderate medical treatment required
Minor first aid required
Insignificant injuries not requiring first aid
LIKELIHOOD: How likely are those consequences?
Almost certain expected to occur in most circumstances
Likely will probably occur in most circumstances
Possible could occur at some time
Unlikely is not likely to occur in normal circumstances
Rare may occur only in exceptional circumstances
LIKELIHOOD
Almost
Rare Unlikely Possible Likely
Certain
IMPACT 1 2 3 4
5
Catastrophi
c M M H C C
A
Major
L M M H C
B
Moderate
L M M M H
C
Minor
L L M M M
D
Insignifican
t VL VL L L M
E
Risk level Required action
Act immediately:
Critical The proposed task or process activity must not proceed. Steps must be taken to lower the
risk level to as low as reasonably practicable using the hierarchy of risk controls.
Act today:
The proposed activity can only proceed, provided that:
(i) the risk level has been reduced to as low as reasonably practicable using the
hierarchy of risk controls;
High (ii) the risk controls must include those identified in legislation, Standards, Codes
of Practice etc.
(iii) the risk assessment has been reviewed and approved by the Supervisor and
(iv) The supervisor must review and document the effectiveness of the
implemented risk controls.
Act this week:
The proposed task or process can proceed, provided that:
Medium (i) the risk level has been reduced to as low as reasonably practicable using the
hierarchy of risk controls;
(ii) the risk assessment has been reviewed and approved by the Supervisor.
Act this month:
Low Managed by local documented routine procedures which must include application of the
hierarchy of controls.
Keep a watching brief:
Very Low Although the risk level is low the situation should be monitored periodically to determine if
the situation changes.
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ACT OHS Commissioner OHS Risk Rating Table Effective date: 07/04/2009
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ACT OHS Commissioner OHS Risk Rating Table Effective date: 07/04/2009
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