Risk assessment checklist

Template Questions

• (1). Crushing - Can anyone be crushed due to:
• Other factors?
• 1. Elimination. 2. Substitution. 3. Engineering Controls. 4. Isolation. 5. Administrative Controls. 6. PPE
• Can be entangled due to:
• (2). Entanglement
• Can anyone be cut, stabbed or punctured due to?
• (3). Cutting, Stabbing and Puncturing
• Can anyone’s body parts be:
• (4). Shearing / Burning / Friction
• Can anyone be struck by moving objects due to:
• (5). Striking
• Can anyone come into contact with?
• (6). High Pressure Fluid /Gases
• Can anyone be injured by electrical shock due to:
• (7). Electrical
• Can anyone’s health be affected by exposure to:
• (8). Gases or Vapors
• 1. Elimination. 2. Substitution. 3. Engineering Controls. 4. Isolation. 5. Administrative Controls. 6
• Can anyone using the plant, or in the vicinity of the plant, slip, trip or fall due to:
• (9). Slips, Trips or Falls
• (10). Manual Handling
• Can anyone be suffocated due to:
• (11). Suffocation
• Can anyone’s health be affected by extreme temperatures by:
• (12). Temperature
• Is lighting acceptable in this area?
• (14). Light
• Is noise acceptable in this area?
• Noise
• Could the plant create hazardous conditions other than above mentioned categories including:
• (13). Other Hazards
• CLASSIFICATION1. FACTOR
• a. Catastrophe; numerous fatalities; major disruption of activities 100
• b. Disaster; multiple fatalities; 50
• c. Very serious; Fatality; 25
• d. Serious; serious injury (amputation, permanent disability) 15
• e. Important; disabling injury; 5
• f. Noticeable; minor cuts, bruises, bumps; minor damage. 1
• a. Continuously (or many times daily) 10
• b. Frequently (approximately once daily). 6
• c. Occasionally (from once per week to once per month) 3
• d. Infrequent (from once per month to once per year). 2
• e. Rarely (it has been known to occur) 1
• f. Very rarely (not known to have occurred) 0.5
• a. Almost certain likely or expected result; 1 in 10 chance. 10
• b. Quite possible/not unusual; 1 in 10 to 1 in 100 chance 6
• c. Would be an unusual sequence or coincidence; 1 in 100 to 1 in 1000 chance 3
• d. Would be a remotely possible coincidence 1 in 1000 to 1 in 10,000 chance. 1
• e. Has never happened after many years of exposure, but is conceivably possible; 1 in 10 000 to 1 in
• f. Practically impossible sequence (has never happened) 1 in 100,000 chance or lower 0.1
• 500 Very high risk Immediate action required. HIGH PRIORITY.
• 300- 499 High risk Management attention needed. Hazards NOT adequately controlled.
• 150- 299 Substantial risk Management attention needed. Hazards NOT adequately controlled.
• 60- 149 Moderate risk Hazard must be examined against current standards
• 0- 59 Low risk Manage by routine procedures.
• - Is it possible to eliminate the risk?
• - Is it possible to reduce the level of risk posed by the hazard by (priority order.
• · Substitution (using less hazardous alternatives)
• · Isolation (separating the operator from the risk)
• · Engineering controls (re-designing plant or equipment).
• - Is it possible to reduce the level of risk posed by the hazard by changing operating procedures, tr
• - Is it possible to reduce the level or risk posed by the hazard by wearing personal protective equip
• Completed by date/time Date
• Responsibility
• Issue identified. Comment on progress/update for actions
• Select date Date
• Auditor to sign here