Fillable Printable Risk Assessment Control Form
Fillable Printable Risk Assessment Control Form
Risk Assessment Control Form
OHS Hazard Identification, Risk Assessment & Control
RISK ASSESSMENT & CONTROL FORM
Task or hazard description: Mountain Bike Ride 25
th
August 2013
Assessment conducted by: Insert your name here
Consulted with:
Assessment date: Date of Assessment
Refer to legislation, standards, codes of practice
etc:
RISK ASSESSMENT MATRIX
CONSEQUENCES
1. Identification:
Consider the individual steps in a task & identify the hazards
that exist. Use specific hazard report forms and checklists for
manual handling, plant, hazardous substances, machinery,
confined space, ergonomics. Also use workplace inspection
checklist, incident reports, MSDS & register of injuries.
2. Assessment:
Consider the following factors – frequency & duration of
exposure, severity of injury/illness, capability & skills, age &
experience of people undertaking the work, layout & condition
of work environment, systems of work being used.
Is the risk increased by additional factors?
Use the matrix to determine the risks of each potential hazard
to get a risk rating.
3. Control:
Determine control measure based on practicability, hierarchy
of control & level of risk. Start from Elimination & work
down to ensure all possible control measures are
considered & documented.
Hierarchy of Control
1. Elimination
2. Substitution
3. Isolation
4. Reduction - Engineering
- Administration
5. Personal Protective Equipment
LIKELIHOOD
1
(Insignificant)
2
(Minor)
3
(Moderate)
4
(Major)
5
(Catastrophic)
A (Almost Certain)
H
H
E
E
E
B (Likely)
M
H
H
E
E
C (Possible)
L
M
H
E
E
D (Unlikely)
L
L
M
H
E
E (Rare)
L
L
M
H
H
Likelihood:
A = is expected to occur inmost instances
B = will probably occur in most instances
C = might occur at some
D = could occur at some time
E = may occur only in exceptional circumstances
Consequences:
1 = No injuries, low financial loss
2 = First aid treatment on-site release immediately
contained, medium financial loss
3 = Medical treatment required, on-site release
contained with outside assistance, high financial
loss
4 = Extensive injuries, loss of production capability,
off-site release with no detrimental effects,
major financial loss
5 = Death, toxin, release off-site with detrimental
effect, huge financial loss
RISK RATING:
E = Extreme: Immediate action to remove or reduce risk required
H = High: Remove or reduce risk in 1-7 days, required senior management attention
M = Medium: Remove or reduce risk in 8-14 days, requires specific management responsibility
L = Low: Need to monitor to ensure risk does not escalate, manage by routine procedures
Page 2
RISK
ASSESSMENT
HAZARDS
RISK
RATING
CONTROL MEASURES REQUIRED
BY
WHOM
BY
WHEN
REVIEW
DATE
Which element
of risk
assessment is
identified ?
Describe particular potential
hazard
Assess
the risk
level
Describe the measures you have implemented to reduce/ eliminate the risk
