Occupational Health and Safety Baseline risk assessment template

Business/Operating unit: Department:

Date: Prepared by: Authorised by:

Name:

Designation:

Signed:

Date:

Refer to Occupational Health and Safety Risk assessment procedure 32-520

Activity type What are the possible

List activity Hazard nr Hazard Identification Risk Nr Associated risk Risk type Cause(s) of the risk Exposed group/employees Risk Owner Exposure patterns Existing Controls
(Routine/Non-routine) consequences?

Risk Priority Rating

Include:
- Preventative Controls
(controls implemented to eliminate hazards or reduce the
Indicate R or N likelihood of the risk occurring), and

Consequence
Who is accountable for making
1. Routine activities and situations create - Reactive Controls

Likelihood
sure the controls and monitors are:
List specific activities to be performed taking hazards through day-to-day operations Who is exposed to the hazard The frequency and duration the (controls implemented to reduce the immediate impact of the RCE
Anything with potential to cause of harm. A chance that injury , ill health or damage could Safety or - in place, Consider the worse case scenario
into consideration the equipment to be used, and normal # # What causes the risk to come into effect? i.e. visitors, members of the person/group is exposed to the hazard e.g. risk occurring) Risk Control
Note: A hazard can pose more than one risk. occur as a result of uncontrolled hazard. health - implemented, without controls?
the personnel involved in the task. work activities; public, etc. Daily for 3 hrs. Effectiveness
- regularly reviewed for
2. Non-routine activities and situations Elimination
effectiveness.
are occasional or unplanned; Substitution
Engineering controls
Administrative controls
Personal protective equipment (PPE)
 Next Review Date Template identifier: 240-70044602
(every 2 years):

me:
Document identifier R Safety 1A Fully effective I

gnation: II
Revision number: 1 N Health 2B Mostly effective

ed: III
Revision date: 31-May-24 3C Mostly ineffective
e: IV
4D None
5E

Additional Controls or Tasks Aimed at improving Existing Legal and Other Integrated Risk Management (IRM)
Monitoring Mechanisms Control Owner Target Date Current Status
Controls Requirements reference number

Include:
- Preventative Controls
(controls implemented to eliminate hazards or reduce the
likelihood of the risk occurring), and
How we know if we are
- Reactive Controls
succeeding. Include comments on Where relevant, list the
(controls implemented to reduce the immediate impact of the Person allocated the Once a date has been Pending, Where applicable, add IRM system
effectiveness. relevant legislative and or
risk occurring) responsibility for implementing agreed to, this can not be In Progress, reference number for tracking of 6 III II I I I
This may include i.e. Eskom requirements that
the agreed controls changed Complete treatment actions.
measurements, inspections, prescribe the control.

Consequences
Elimination
supervision where necessary.
Substitution
Engineering controls
Administrative controls
Personal protective equipment (PPE)

5 III II II I I
4 IV III II I I
3 IV III II II I
2 IV IV III II II
1 IV IV III III III
A B C D E
Likelihood
 Occupational Health and Safety Baseline risk assess

Business/Operating unit:

Date:

Refer to Occupational Health and Safety Risk assessment pr

What are the possible

List activity Hazard Identification Associated risk Risk type
consequences?
List specific activities to be performed taking
Anything with potential to cause of harm. A chance that injury , ill health or damage could Safety or Consider the worse case scenario
into consideration the equipment to be used,
Note: A hazard can pose more than one risk. occur as a result of uncontrolled hazard. health without controls?
the personnel involved in the task.

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ty Baseline risk assessment template
Next Review Date Template identifier:
(every 2 years):

Authorised by:
Name:
Document identifier
Designation:
Revision number: 1
Signed:
Revision date: 31-May-24
Date:

Safety Risk assessment procedure 32-520

Legal and Other

Existing Controls Control Owner
Requirements

Risk Priority Rating

 Risk Priority Rating
Include:
- Preventative Controls
(controls implemented to eliminate hazards or reduce the
likelihood of the risk occurring), and

Consequence
- Reactive Controls

Likelihood
Where relevant, list the
(controls implemented to reduce the immediate impact of the RCE Person allocated the
relevant legislative and or
risk occurring) Risk Control responsibility for implementing
Eskom requirements that
Effectiveness the agreed controls
prescribe the control.
Elimination
Substitution
Engineering controls
Administrative controls
Personal protective equipment (PPE)

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 6 III II I I I

Consequences
5 III II II I I
4 IV III II I I
3 IV III II II I
2 IV IV III II II
1 IV IV III III III
A B C D E
Likelihood
R Safety 1A Fully effective I

II
N Health 2B Mostly effective

III
3C Mostly ineffective
IV
4D None
5E

6
Consequence rating

5
6
Consequence criteria
Description

Health and Safety

No injuries or health effects(near misses)

First-aid treatment case, and temporary discomfort case

Medical treatment case; occupational disease with reversible/non-permanent effect

Lost Time Injury. Irreversible health effects/occupational disease with permanent consequence

Fatality or life threatening health effects

Multiple fatalities
 Likelihood criteria
Score Descriptor Safety Occupational hygiene
Exposure
§ More than a “100 year event”
§ Exceptionally unlikely, even in the long-
A Highly unlikely
term future
Rare (once a year)

§ < 5% probability.
§ Could occur in “years to decades”
Short periods of time, a few times per
B Unlikely § May occur but not anticipated day/ intermittent (once in six months,
three months, or a month)
§ ≥ 5% and < 20% probability.

§ Could occur within “months to years”

Continuous for between one and two
C Possible § May occur shortly but a distinct hours (often/ weekly)
probability it will not, or ≥ 20% and < 70%
probability.

§ Could occur within “weeks to months”

Continuous for between two and four
D Likely
§ Balance of probability will occur hours (frequent/daily)
§ ≥ 70% and < 90% probability.

§ Could occur within “days to weeks”

E Unavoidable
§ Impact is imminent
Continuous for eight-hour shift

§ ≥ 90% probability.
Probability of exceeding OEL

No exposure (or exposure < 10% of OEL)

Low exposure (< 50% of OEL)

Moderate exposure (chronic exposure > 50%

of OEL or acute exposure ≥ OEL)

High exposure (chronic exposure > OEL, or

gv g
exposure exceeding OEL-STEL)

Very high exposure (chronic exposure > 2 x

OEL or exposure exceeding OEL-C)
 RISK CONTROL EFFECTIVENESS GUIDE
RCE

Fully effective

Mostly effective

Mostly ineffective

None
SK CONTROL EFFECTIVENESS GUIDE
Guide
Nothing more to be done except review and monitor the existing controls.
Controls are well designed for the risk, are largely preventive and address
the root causes. Management believes that they are effective and reliable
at all times. Reactive controls only support preventive controls.

Most controls are designed correctly and are in place and effective. Some
more work to be done to improve operating effectiveness or management
has doubts about operational effectiveness and reliability of the controls.

While the design of controls may be largely correct in that they treat most
of the root causes of the risk, they are not currently operationally very
effective. There may be an over-reliance on reactive controls, or some of
the controls do not seem correctly designed in that they do not treat root
Virtually no credible control. Management has no confidence that any
degree of control is being achieved.
 RISK MATRIX
6 I I

5 II II
Consequences
4 III III

3 IV III

2 IV IV

1 IV IV
A B
Likelihood

Priority Risk ranking Action required

Immediate action required, and these risks to

I Very high
be captured on IRM system.
Strong mandatory action required, and these
II High
risks to be captured on IRM system.
Action required, possibly at administrative
III Medium
level.

IV Low Minor or no action required.

 RISK MATRIX
I I I

II I I

II I I

II II I

III II II

III III III

C D E
Likelihood

Action required

ction required, and these risks to

on IRM system.
datory action required, and these
aptured on IRM system.
ed, possibly at administrative

action required.