WORK HEALTH AND SAFETY FORM
Topic
WHS Risk Assessment
Section 1 – Activity Description
Date of Assessment:
Description of Activity/Hazard/Risk:
Work Site/Location:
Assessment Conducted by:
BACKGROUND INFORMATION
Reason for Assessment:
Other Relevant Information:
PHOTOS/DIAGRAMS
Topic:
Document Location:
Uncontrolled if Printed
WHS Risk Assessment
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 Hazard
Hazard
Mechanical/Kinetic
Contact with moving plant/parts (cutting, shearing, entanglement, etc)
Contact with sharp objects/edges
Contact with moving vehicles/mobile plant
Struck by projectiles or ejected items (including struck in eye by object)
Mechanical damage to services, PPE or other items
Gravitational
Fall from height
Falling object from height
Slips and trips
Access/work beneath a suspended load/unstable object
Thermal and/or Explosive
Fire/Explosion
Ignition of gas/dust in a hazardous area
Contact with hot/cold objects/parts
Excessively hot/cold environments (including heat stress)
Electrical
Contact with live electrical parts (overhead power line, etc)
Exposure to high fault currents (within switchboards, battery banks)
Mechanical damage to power leads/fixed electrical wiring
Ingress of water into electrical components
Noise and/or Vibration
Exposure to increased noise (levels that may cause hearing damage)
Contact with vibrating plant/vehicles/tools/objects
Environmental
Air/ground/water contamination (including spills, uncontrolled release, etc)
Release of harmful solid, liquid or gas during transport on/off site
Incorrect waste disposal
Import of unauthorised soils, materials, plants or machinery
Pressurised
Release of stored gas, liquid, solid under pressure
Release of spring/tension energy
Topic:
Document Location:
Uncontrolled if Printed

Chemicals/Substances
Inhalation of dusts, gases, fumes, vapours and mists
Ingestion of chemicals/substances
Absorption of chemicals/substances through skin
Radiation
Exposure to ionising radiation source (industrial radiography, non-destructive
testing)
Exposure to non-ionising radiation source (laser, welding flash, infrared,
radiofrequency)
Biological
Exposure to algal, bacterial, fungal, viral or parasitic agents (skin contact,
ingestion, inhalation)
Animal, insect and spider bites/stings
Sharps/needle-stick exposure
Manual Handling/Postural
Handling heavy, unstable or awkward objects/loads
Repetitious movements
Maintaining static or awkward postures
Tool use that requires excessive force
Psychological/Mental, Social, Medical
Working for excessive time periods and/or while fatigued
Exposure to workplace bullying, harassment, violence
Work Environment
Inadequate lighting
Wet/slippery/uneven/unstable work surface
Weather conditions (including flooding, lightning, wind)
Working alone
Unfavourable atmospheric conditions (dusty)
Restricted access or working space
Other:
Aviation:
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Step 1 – Consider Consequences
Step 2 – Consider Likelihood
What are the consequences of the hazard occurring? Consider what is the most probable consequence (below) with
respect to this work hazard
What is the likelihood (below) of the hazard consequence
in Step 1 occurring.
Workplace Safety
Legislative & Regulatory
Serious breach of regulatory duty resulting in
prosecutions against corporation and/or individuals or
Prohibition Notice issued against critical infrastructure
(operational impact)
Extreme
Could result in death, permanent total
disabilities or severe injuries affecting multiple
persons
Critical
Could result in permanent partial disabilities or
injuries or illness resulting in hospitalisation of
multiple persons
Non-compliance with WHS legislation resulting in
notifiable incident or Prohibition Notice against non-critical
infrastructure (no major operational impact)
Major
Could result in injury or illness LTI 5 shifts or
more
Non-compliance with WHS legislation to which a penalty
applies (fines, improvement notice etc)
Possible
Might occur at some time (between once
per year and once in 5 years)
Moderate
Could result in injury or illness resulting in LTI
(max 4 shifts)
Non-compliance with WHS legislation (excluding
notifiable incidents
Unlikely
Could occur at some time (between once in
5 years and once in 20 years)
Minor
Minor injury or illness not resulting in lost work
day
Non-conformance with non-regulatory BAC requirement
Almost Certain
Is expected to occur in most circumstances
(once per month)
Likely
Will probably occur at least once (between
once per month and once per year)
Rare
May occur in exceptional circumstances
(once in more than 20 years)
Step 3 – Calculate Risk
Consequences
Take Step 1 rating and select correct column
Take Step 2 rating and select correct row
Use the risk score where the two ratings cross on the
matrix below
Likelihood
1.
2.
3.
VH = Very High
H = High
M = Medium
L = Low
Topic:
Document Location:
Uncontrolled if Printed
Minor (5)
Moderate (4)
Major (3)
Critical (2)
Extreme (1)
Almost Certain
(A)
Medium (A5)
High (A4)
Very High (A3)
Very High (A2)
Very High (A1)
Likely (B)
Medium (B5)
High (B4)
High (B3)
Very High (B2)
Very High (B1)
Possible (C)
Low (C5)
Medium (C4)
Medium (C3)
High (C2)
Very High (C1)
Unlikely (D)
Low (D5)
Low (D4)
Medium (D3)
Medium (D2)
High (D1)
Rare (E)
Low (E5)
Low (E4)
Low (E3)
Medium (E2)
High (E1)
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Description of Hazard
Topic:
Document Location:
Uncontrolled if Printed
Control Measures
(Detail any existing
controls)
Description of Risk
Risk Analysis
C
L
Additional Controls
(detail additional controls
to be implemented)
Risk
Rating
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Risk Analysis
(with additional controls)
Risk
C
L
Rating
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Section 4 – Risk Assessment Control / Action Timetable
Required control and / or action
Decision of Acceptability of Risk (with
above actions in place):
Approved By: Name
Responsible Person
Due Date
ACCEPTABLE / NOT ACCEPTABLE
Signature
Comments:
Topic:
Document Location:
Uncontrolled if Printed
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