14.1 Risk Identification and Assessment TEMPLATE

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?14.1
?Risk
?Identification
?and
?Assessment
?TEMPLATE.docx
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FORM 14.1 RISK IDENTIFICATION AND ASSESSMENT TEMPLATE
Site:
Area Assessed
Describe the specific
location of the hazard
Assessment completed by:
What are the
Hazards?
Existing Controls
Date:
What actions are required?
Enter further actions required to remove/manage the
risk refer to table 2 below for priority requirements
Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
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Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
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Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
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Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
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Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
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Risk Rating
Refer to table 1
below
-
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Review
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Updated:
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?14.1
?Risk
?Identification
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?Assessment
?TEMPLATE.docx
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?14.1
?Risk
?Identification
?and
?Assessment
?TEMPLATE.docx
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Area Assessed
Describe the specific
location of the hazard
What are the
Hazards?
Existing Controls
What actions are required?
Enter further actions required to remove/manage the
risk refer to table 2 below for priority requirements
Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
/
/
Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
/
/
Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
/
/
Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
/
/
Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
/
/
Action Owner: ¡¡¡¡¡¡¡¡¡Due date:
/
/
Revision:
?
?1
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?
?
?
?
?
?
?
?
?
?
?
?
?
Review
?By:
?30/6/13
?
Updated:
?14/04/12
?4:36
?PM
?
UNCONTROLLED
?WHEN
?PRINTED
?Last
?Printed:
?14/04/12
?4:36
?PM
?-?©\
?for
?up
?to
?date
?copy
?refer
?to
?the
?online
?version
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Doc
?Name:
?14.1
?Risk
?Identification
?and
?Assessment
?TEMPLATE.docx
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Risk Rating
Refer to table 1
below
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?14.1
?Risk
?Identification
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How likely is it to be that bad?
++
Very likely.
Could happen at any
time
+
Likely.
Could happen
sometime
Unlikely.
Could happen but
rarely
-Very unlikely.
Could happen but
probably never will
1
2
3
!!!
Long term illness or serious injury
1
1
2
3
4
!!
Medical attention & days off work
2
3
4
5
!
First aid needed
3
4
5
6
Table 1 ¨C Risk Assessment Matrix
How severe could
the outcome be?
DEATH
Death, permanently disability or ill health
CONSEQUENCE
Table 2 ¨C Severity Rating by WHS, Environment and Quality Standards and Associated Action Priority
WHS
Environmental
Quality
RISK
ACTION PRIORITY
!!!
!!
!
Kill or cause permanent
disability or ill health
Critical environmental issue or
pollution potential that could threaten
the survival of the organization
Critical quality issue. Could
threaten the survival of the
organisation
1-2
Immediate action required
to reduce the risk
Cause long term illness or
permanent injury
Long term pollution or significant cost
to organisation
Recall or significant cost to
organisation
3-4
Action in a timely manner,
WMS to be completed
Transient pollution requiring clean up
or cost to organisation
Customer complaint involving
non conforming product
5-6
Schedule action to review
and reduce the risk
Minor pollution No clean up required
Minor non conformance detected
before it reaches the customer
Cause someone to need
medical attention and be off
work for several days
Cause someone to need first
aid
ALL RISKS MUST BE ELIMINATED
WHERE POSSIBLE
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Review
?By:
?30/6/13
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Updated:
?14/04/12
?4:36
?PM
?
UNCONTROLLED
?WHEN
?PRINTED
?Last
?Printed:
?14/04/12
?4:36
?PM
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?to
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Doc
?Name:
?14.1
?Risk
?Identification
?and
?Assessment
?TEMPLATE.docx
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?14.1
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Signoff of Risk Assessment and Actions
Completed by: .¡¡¡¡¡¡¡¡¡¡¡¡¡..¡
Signature: ...¡¡¡..............¡¡¡¡.... Date: ¡¡¡¡¡
Agreed by Manager: ¡¡¡¡¡¡¡¡¡..¡¡..
Signature: ...¡.......¡¡¡¡¡...¡....... Date: ¡¡¡¡¡
Comments:
* NOTE ¨C this form is to be used to identify risks and provide a preliminary assessment. The Company SEQ System form 19.1 (Corrective
Action Report) must be completed for all medium to high risks which are not able to be mitigated immediately.
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Review
?By:
?30/6/13
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Updated:
?14/04/12
?4:36
?PM
?
UNCONTROLLED
?WHEN
?PRINTED
?Last
?Printed:
?14/04/12
?4:36
?PM
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Doc
?Name:
?14.1
?Risk
?Identification
?and
?Assessment
?TEMPLATE.docx
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?14.1
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?Identification
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PROCESS TO BE CARRIED OUT
The process of risk ranking any hazard above should be carried
out in the following manner:
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Ensure that the consultative group has sufficient expertise
and information regarding the hazard.
Identify a realistic scenario and assess the probable severity
or other impact. Table 1
Assess in consultation with other employees the probability
of the chosen severity occurring.
From Matrix 1 read off the number at the meeting point of
the column & row selected.
The risk rating priority is the Word shown against the number
in Table 1.
This risk ranking will be used to determine the priority given to
reducing the hazard and the type of controls applied. Finally we
need to decide on the controls or safeguards that we need to
apply to the risk. Sometimes this is obvious and sometimes the
control is defined in legislation but in other cases we need to
apply controls on the basis of the control hierarchy and work our
way down until we come across a viable control.
Revision:
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Review
?By:
?30/6/13
?
Updated:
?14/04/12
?4:36
?PM
?
UNCONTROLLED
?WHEN
?PRINTED
?Last
?Printed:
?14/04/12
?4:36
?PM
?-?©\
?for
?up
?to
?date
?copy
?refer
?to
?the
?online
?version
?
Doc
?Name:
?14.1
?Risk
?Identification
?and
?Assessment
?TEMPLATE.docx
?
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