Fillable Printable Plant Risk Assessment Sample Form
Fillable Printable Plant Risk Assessment Sample Form
Plant Risk Assessment Sample Form
97
Golden Plains Shire Council - Resource Manual
Form 18: Plant Risk Assessment
PLANT: Organisation:
Howistheplantused? Whousestheplant?
Hazard Risk Determined
ControlMeasures
Implemented
by:
Expected
dateof
completion
Signoffon
completion
Dateof
Completion
Probability
Consequence
RiskRating
StepOne – For each hazard select one category
from Probability column and one category from the
Consequence columns
StepTwo – Plot both (P) & (C) onto the Matrix
StepTwo –
Address High and
Medium risks
RiskRatingMatrix
(Probability) Consequence(C)
A B C D E
1
Expected
A
Death
1 High High High Medium Medium
2
Often
B
Permanent Disability
2 High High Medium Medium Low
3
Sometimes
C
Lost Time Injury
3 High Medium Medium Low Low
4
Rarely
D
Medical Treatment
4 Medium Medium Low Low Low
5
Highly Unlikely
E
First Aid Injury
5 Medium Low Low Low Low
