HS017
HS Risk management form
For additional information refer to HS329 Risk Management Procedure
Faculty/Division: School/Unit:
Document number Initial Issue date Current version Current Version Next review date
Issue date
Risk management name
Form completed by Signature Date
Responsible supervisor/ authorising officer Signature Date
Identify who may be at risk from the activity:
List legislation, standards, codes of practice, manufacturer’s guidance etc used to This may include fellow workers, visitors, contractors and the public. The types of people may
affect the risk controls needed and the location may affect the number of people at risk
determine control measures necessary
Persons at risk
Work Health and Safety Act 2011
Work Health and Safety Regulation 2017
How they were
consulted on the risk
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Risk Rating Matrix
RISK RATING METHODOLOGY AND MATRIX
Consider the Consequences Consider the Likelihood Calculate the Risk
Consider: What type of harm could occur (minor, serious, Consider: How often is the task done? Has an accident [Link] the consequences rating and select the correct column
death)? Is there anything that will influence the severity happened before (here or at another workplace)? How long are
(e.g. proximity to hazard, person involved in task etc.). [Link] the likelihood rating and select the correct row
people exposed? How effective are the control measures? Does
How many people are exposed to the hazard? Could one the environment effect it (e.g. lighting/temperature/pace)? What 3. Select the risk rating where the two ratings cross on the matrix below.
failure lead to other failures? Could a small event are people’s behaviours (e.g. stress, panic, deadlines) What
escalate? people are exposed (e.g. disabled, young workers etc.)? VH = Very high, H = High, M = Medium, L = Low
CONSEQUENCES
5. Severe: death or permanent disability to one or A. Almost certain: expected to occur in most circumstances
1 2 3 4 5
more persons
OOD LIKELIH
B. Likely: will probably occur in most circumstances A M H H VH VH
4. Major: hospital admission required B M M H H VH
C. Possible: might occur occasionally C L M H H VH
3. Moderate: medical treatment required
D. Unlikely: could happen at some time D L L M M H
2. Minor: first aid required E L L M M M
E. Rare: may happen only in exceptional circumstances
1. Insignificant: injuries not requiring first aid
Risk Required action
level
Very high Act immediately: 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
High 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 and
(ii) the risk controls must include those identified in legislation, Australian Standards, Codes of Practice etc. and
(iii) the document has been reviewed and approved by the Supervisor and
(iv) a Safe Working Procedure or Safe Work Method has been prepared and
(v) the supervisor must review and document the effectiveness of the implemented risk controls
Medium Act this week: The proposed task or process can proceed, provided that: (i) the risk level has been reduced to as low as reasonably practicable using the hierarchy of controls and
(ii) the document has been reviewed and approved by the Supervisor and
(iii) a Safe Working Procedure or Safe Work Method has been prepared.
Low Act this month: Managed by local documented routine procedures which must include application of the hierarchy of controls.
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List emergency procedures and controls
List emergency controls for how to deal with fires, spills or exposure to hazardous substances and/or emergency shutdown procedures
REVIEW
Scheduled review date:
Are all control measures in place?
Are controls eliminating or minimising the risk?
Are there any new problems with the risk?
Review by: (name)
Review date:
Acknowledgement of Understanding
All persons performing these tasks must sign that they have read and understood the risk management (as described in HS329 Risk Management Procedure).
Note: for activities which are low risk or include a large group of people (e.g. open days, BBQ’s, student classes etc), only the persons undertaking the key activities need to sign below. For all others involved in such
activities, the information can be covered by other methods including for example a safety briefing, induction, and/or safety information sheet (ensure the method of communicating this information is specified here)
Risk management name and version number: I have read and understand this risk management form
Name Signature Date
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