6.4.1.1 - Risk Assessment Form
Activity or Task
being assessed:
Workers Involved in
the Risk Assessment:
Item
Item
RSA CERTIFICATE
LYN MCKENRY
Step 1 – Identify the
Hazard(s) - A hazard can
be defined as a source or
a situation with a potential
for harm in terms of
human injury or ill-health,
damage to property,
damage to environment,
or a combination of these
Step 2 – Assess the
Risk - When
conducting a risk
assessment YOU MUST
consider what could
happen if someone is
exposed to a hazard
(consequences), the
likelihood of it
happening and how
long the worker is
exposed to the
hazard.
What could cause
Harm?
(Hazard)
What could go
Wrong?
(Risk)
1
Students travelling to
school
Accident
2
Number of Students
Student numbers
capped at 30
Date of assessment:
10 May 2023
Reference #:
(e.g. Area/location)
St Mary’s Student LHUB
Step 3 – Reduce the Risk - What
controls are currently in place?
Current Controls
Students have parental
permission to drive/travel to
school. Parents will be
contacted if accident is
close to school
2 Supervisors will attend if this
is he final number
Diocese of Maitland Newcastle
Issue Date: 22/01/2019
Completed by:
Step 4 –
Rank the
Risk – Use
the Risk
Matrix
and put
the
outcome
here
Step 5 – Further reduce the risk
if possible – Determine if there
are further controls that can be
put into place. What are the
most suitable controls to further
reduce the risk?
Risk
Ranking
Further Recommended
Controls
LYN MCKENDRY
Step 6 – Monitor & Review - How
will the risk be monitored and
who has the responsibility?
Use ‘Hierarchy of Control’ from
top down and combine
multiple controls if needed to
reduce risk to as low as
reasonably practicable.
Actions Required?
(Refer to
Matrix)
L
By
Whom
Step 7 – Is it
safe to
proceed? – If it
the Risk
Ranking is
Extreme or
High the
Principal or
Manager must
sign off and
the WHS Team
must be
contacted for
advice
Safe to
proceed
Y/N
Y
L
6.4.1.1 - Risk Assessment Form
Next Review Date: 22/01/2021
Confidentiality Level – Open Access
ASC ST MARY’S CAMPUS
Agency:
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CATHOLIC DIOCESE OF MAITLAND-NEWCASTLE | 6.4.1.1 - Risk Assessment Form
Item
3
What could cause
Harm?
(Hazard)
Student Physical
capability
What could go
Wrong?
(Risk)
Current Controls
Risk
Ranking
Further Recommended
Controls
Actions Required?
By
Whom
(Refer to
Matrix)
L
Student not well
or incapacitated
Safe to
proceed
Y/N
Staff to check with students
they have no physical
problems on the day.
4
Incident/injury
Injured eg fall
Supervisor will inform
L
First Aid
down stairs or ill
teacher. Staff member from
Student
student services would
render First Aid
Note: If the initial risk is rated as High or Extreme, a copy of this document, once completed, must be forwarded to the Safety & Wellness Team for review
STEP 1 - Rate the Consequence - Evaluate the consequences of a risk
occurring according to the ratings in the top row
Descriptor
Insignificant
Minor
Moderate
STEP 2 - Rate the Likelihood - Evaluate the likelihood of an incident
occurring according to the ratings in the left-hand column
Definition
Descriptor
No injury
Rare
Injury/ill health requiring first aid
Unlikely
Injury/ill health requiring medical attention
Possible
Major
Injury/ill health requiring hospital admission
Likely
Severe
Fatality
Almost
Certain
Diocese of Maitland Newcastle
Issue Date: 22/01/2019
Definition
May occur somewhere, sometime (“once in a life time /
once in a hundred years”)
May occur somewhere within the Department over an
extended period of time
May occur several times across the Department or a
region over a period of time
May be anticipated multiple times over a period of time
May occur once every few repetitions of the activity or
event
Prone to occur regularly
It is anticipated for each repetition of the Activity or Task
6.4.1.1 - Risk Assessment Form
Next Review Date: 22/01/2021
Confidentiality Level – Open Access
Revision No. 0
HPE RM Ref:TBA
Not Controlled When Printed
Page 2 of 3
y
y
CATHOLIC DIOCESE OF MAITLAND-NEWCASTLE | 6.4.1.1 - Risk Assessment Form
STEP 3 - Utilise the Risk Matrix to calculate the level of risk by finding
the intersection between the likelihood and the consequences
Likelihood
STEP 4 - Determine the appropriate action using the Risk Level/Rating and
Actions
Descriptor
Consequence
Insignificant
Minor
Moderate
Major
Severe
Almost
Certain
Medium
High
Extreme
Extreme
Extreme
Likely
Medium
Medium
High
Extreme
Extreme
Possible
Low
Medium
Medium
High
Extreme
Unlikely
Low
Low
Medium
Medium
High
Rare
Low
Low
Low
Medium
Medium
Extreme
High
Medium
Low
Diocese of Maitland Newcastle
Issue Date: 22/01/2019
Definition
Notify the Principal/Manager and/or Management WHS
Nominee immediately. Corrective actions should be
taken immediately. Cease associated activity. Contact
the Safety & Wellness Team for assistance
Notify Principal/Manager and/or Management WHS
Nominee immediately. Corrective actions should be
taken within 48 hours of notification. Contact the Safety
& Wellness Team for assistance
Notify Nominated employee, HSR/WHS Committee.
Nominated employee, WHS Representative/WHS
Committee is to follow up that corrective action is taken
within 7 days.
Notify Nominated employee, HSR/WHS Committee.
Nominated employee, HSR/WHS Committee is to follow
up that corrective action is taken within a reasonable
time - monitored at WHS Meetings
6.4.1.1 - Risk Assessment Form
Next Review Date: 22/01/2021
Confidentiality Level – Open Access
Revision No. 0
HPE RM Ref:TBA
Not Controlled When Printed
Page 3 of 3