Risk Assessment control form – 5 Hazards you have identified in your

SITE INSPECTION ASSESSMENT (YOUR WORKPLACE – INSPECTION CHECKLIST WAS PROVIDED)

Complete all parts of the risk assessment control form.

Site Supervisor/ Amanda Corrin

manager:
3rd June 2020
Date:

Name of person Amanda Dos Santos

completing risk
assessment

Hazard identification and initial risk rating Control measures and actions
Current control Further
Likelihood of harm Consequence Risk level
Hazard Potential Harm measures & action/controls
occurring level rating
effectiveness required
Inappropriate exterior stumbling, fall to Major Serious Possible check the location install new light points
lighting the ground environmental and assess where
impact future light points
need to be installed

Detergents/cleaners/poisons contamination, Severe/catastrophic Disastrous Likely provide another keep items separate
stored together from poisoning and and/or place to keep the and safe for health
foodstuffs. serious health widespread food in a safe place
risks environmental
impact

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 Hazard identification and initial risk rating Control measures and actions
Current control Further
Likelihood of harm Consequence Risk level
Hazard Potential Harm measures & action/controls
occurring level rating
effectiveness required
Bench height don’t very high and Severe/catastrophic Disastrous Likely check the possibility install and adjust the
appropriate to needs of unstable bench, and/or of new safe and bench at a safe height
users. possible risk of widespread adjustable bench
falls environmental
impact

Pet feeding utensils kept contamination, Severe/catastrophic Disastrous Likely check and arrange keep items separate
together from those used for poisoning and and/or another place to and safe for health
humans. serious health widespread store the pet's food
risks environmental
impact

Chairs and tables in not chairs larger than Major Serious Possible check and exchange install and keep chairs
good order. the table, going environmental chairs for smaller under the table when
beyond the impact sizes not in use
passageway
stumbling, fall to
the ground

Individual Support
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HTLWHS002 AT4 Risk Assessment Control Form

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 Hazard identification and initial risk rating Control measures and actions
Current control Further
Likelihood of harm Consequence Risk level
Hazard Potential Harm measures & action/controls
occurring level rating
effectiveness required

Individual Support
Page |3
HTLWHS002 AT4 Risk Assessment Control Form

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 Risk Rating Matrix

Impact
Rare Unlikely Possible Likely Almost certain

Severe/catastrophic Medium High High Very high Very high

Likelihood

Major Medium Medium High High Very high

Moderate Low Medium High High Very high

Minor Low Low Medium Medium High

Minimal Low Low Medium Medium Medium

RISK LEVELS
Resolution at each level involves reducing the risk level to a lower level of risk
 Extreme – requires immediate assessment with management consideration. A detailed plan, regular monitoring and reporting is required with a
target resolution within 1 month timeframe
 High – requires immediate assessment with senior staff consideration, planning and reporting. Target resolution should ideally be within 3 months
 Medium – reviewing of existing controls and planning required. Resolution timeframe should be within 1 year
 Low – the risk may be tolerable and controlled if managed with high quality process and procedures.

Individual Support
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HTLWHS002 AT4 Risk Assessment Control Form

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 Consequence table

Use the following matrix to rate the consequence of each identified hazard. Where a hazard could have multiple consequences (for example, injury and
financial cost) the highest consequence should be selected.

DESCRIPTION
Consequence Injury Illness Environment Financial cost
Disastrous and/or
Fatality or Fatality or
widespread Huge (greater than
Catastrophic permanent permanent
environmental $500,000)
disability disability
impact
Lost time injury Lost time injury Serious
Major ($50,000–
Major (greater than 2 (greater than 2 environmental
$500,000)
weeks) weeks) impact
Substantial
Lost time injury (less Lost time injury (less High ($20,000–
Moderate environmental
than 2 weeks) than 2 weeks) $50,000)
impact
Requires medical
Requires basic treatment, for Small and / or Medium ($5,000–
Minor
medical treatment example, for skin localised impact $20,000)
rashes
Little or no
Minor, for example Low (less than
Minimal Minor environmental
headache/nausea $5,000)
impact

Individual Support
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HTLWHS002 AT4 Risk Assessment Control Form

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