14.1 Risk Identification and Assessment TEMPLATE



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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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?14.1

?Risk

?Identification

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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:

/

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Action Owner: ¡­¡­¡­¡­¡­¡­¡­¡­¡­Due date:

/

/

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?By:

?30/6/13

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Updated:

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UNCONTROLLED

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Risk Rating

Refer to table 1

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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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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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UNCONTROLLED

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?14.1

?Risk

?Identification

?and

?Assessment

?TEMPLATE.docx

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?14.1

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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.

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Review

?By:

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Updated:

?14/04/12

?4:36

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UNCONTROLLED

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?14.1

?Risk

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?Assessment

?TEMPLATE.docx

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