Risk Assessment Template Sept 20101

Generic OHS Risk Assessment Control FormNote: There are some checklists available for the identification of hazards associated with specific tasks such as Manual Handling, Forklift Safety, Overseas Travel – refer to OHS Web site h t tp:/ /ww w . s w inburn e .edu. a u/co r por a te/hr/ o hs/

CLUB Risk Assessment completed by

Location/Venue Club committee position

Date

Describe the Activity & location

Step 1 Identify the activity

Complex or lengthy activities should be broken down into

stages / alternately aspects of the activity may be

listed

Step 2 What are the hazards?

Step 3 Who might be harmed and

how?Step 4 What are you

already doing?

Current risk

ratingRefer last

page (optional)

Step 5 What further action is necessary?

Apply the Hierarchy of Controls

Refer last page

Residual risk

ratingRefer last

page

(required)

How will the controls be implemented?

Action by Due Date WhenCompleted

Risk Assessment Template Sept 20102

Step 1 Identify the activity

Complex or lengthy activities should be broken down into

stages / alternately aspects of the activity may be

listed

Step 2 What are the hazards?

Step 3 Who might be harmed and

how?Step 4 What are you

already doing?

Current risk

ratingRefer last

page (optional)

Step 5 What further action is necessary?

Apply the Hierarchy of Controls

Refer last page

Residual risk

ratingRefer last

page

(required)

How will the controls be implemented?

Action by Due Date WhenCompleted

Risk Assessment Template Sept 20103

Step 1 Identify the activity

Complex or lengthy activities should be broken down into

stages / alternately aspects of the activity may be

listed

Step 2 What are the hazards?

Step 3 Who might be harmed and

how?Step 4 What are you

already doing?

Current risk

ratingRefer last

page (optional)

Step 5 What further action is necessary?

Apply the Hierarchy of Controls

Refer last page

Residual risk

ratingRefer last

page

(required)

How will the controls be implemented?

Action by Due Date WhenCompleted

HIERARCHY OF CONTROLS Start at the top and work down

MostEffective

LeastEffective

EliminationEg. Discontinue use of product, equipment, cease work process

SubstitutionEg. Replace with a similar item that does the same job but with a lower hazard level

IsolationEg. Put a barrier between the person and the hazard

Engineering controlsEg. Change the process, equipment or tools so the risk is reduced

Administration controlsEg. Guidelines, procedures, rosters, training etc to minimise the risk

Personal protective equipmentEg. Equipment worn to provide a temporary barrier

Risk Assessment Template Sept 20104

RISK ASSESSMENT RATING – Use this table to determine a risk rating

1) What is the worst possible CONSEQUENCE of this hazard?2) What is the LIKELIHOOD of this occurring?

RISK RATING

LIKELIHOOD

CONSEQUENCE

RareThe event will only occur in exceptional circumstances

Unlikely The event is not likely to occur in a year

Possible The event may occur within a year

LikelyThe event is likely to occur within a year

AlmostCertainThe event is almost certainto occur within a year

Catastrophic (Accidental death / serious injury)

SignificantRisk

SignificantRisk High Risk High Risk High Risk

Major(Serious injury) Low Risk

ModerateRisk

SignificantRisk High Risk High Risk

Moderate(Lost time due to workplace injury)

Low Risk Low RiskModerate

RiskSignificant

Risk High Risk

Minor(Minor workplace injury – no lost time)

Low Risk Low Risk Low Risk ModerateRisk

SignificantRisk

Minimal(No injury) Low Risk Low Risk Low Risk Low Risk Moderate

Risk

Documentation and approval

Name

Please print

Signature

Date / /

Contact No.

Verified by club committee member #2

Signature

Date / /