SCHOOL OF ELECTRICAL AND INFORMATION ENGINEERING
RISK ASSESSMENT FORM – RESEARCH
PART 1.
DETAILS OF PROJECT/EXPERIMENT/WORK ACTIVITY
Title of project/experiment/work activity:
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Staff/Student’s Information
Last name:
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First name:
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Position/Degree:
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Supervisor’s name:
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Commencement year:
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Staff/Student ID
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Phone:
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Email:
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Location/Laboratory (where activity will take place):
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Brief description of project/experiment/work activity:
Note:
1. For activities using hardware equipment, experiment titles and equipment involved in each
experiment are required to list here;
2. For activities only using PCs, state “PC only” in the box below and go to Part 6 – Declaration.
Revision date: 14 Jan 2015
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PART 2.
SUMMARY OF POSSIBLE HAZARDS
Voltage Levels - Are voltage levels hazardous to operator?
Specify the voltage level.
Current Levels – Are current level hazardous to operator?
Specify the current level
Ionizing Radiation – Are radiation sources to be used?
Please specify the isotope to be used
Laser – Are lasers to be used?
Please specify Class (power level) of laser to be used
Electrical – Is electrical equipment to be used?
☐Yes
☐No
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☐Yes
☐No
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☐Yes
☐No
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☐Yes
☐No
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☐Yes
☐No
Please attach schedule of electrical equipment to be used and advise the following:
(a) type of equipment,
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(b) maximum voltage present,
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(c) maximum current present,
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(d) maximum instantaneous power of each electrical device.
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Chemicals/Substances –
☐Yes
☐No
Are chemicals/substances hazardous to health to be used?
Please attach a list of hazardous chemicals/gases/substances to be used.
Please advise estimates of quantities of hazardous substances
(a) stored
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(b )used daily
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(c) used throughout the life of the experiment.
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Mechanical – Are you using mechanical, pneumatic, ☐Yes
pressure vessels, hydraulics, motor drives, lifting gear etc?
☐No
Please attach schedule of mechanical equipment to be used and advise the following:
(a )type of equipment
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(b) maximum pressure, weight lifted and other relevant information about
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Revision date: 14 Jan 2015
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the magnitude of risk
Other hazards – Are there any other hazards which pose ☐Yes
unusual risks, such as high temperature/pressure, long
periods at a computer, working at height, manual handling
etc?
☐No
Please attach schedule of other hazards identifying the nature of each hazard.
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Revision date: 14 Jan 2015
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PART 3. RISK ASSESSMENT AND CONTROL MEASURES
Where you have answered ‘yes’ in Part 2 please provide a written 'Safe System of Work' or the control measures to be put into place for
these activities.
Items
Potential Hazards
Control Measures
Risk Priority
1
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Choose an
item.
2
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Choose an
item.
3
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Choose an
item.
4
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Choose an
item.
5
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Choose an
item.
6
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Choose an
item.
7
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item.
8
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Choose
item.
an
Note:
To complete this section, please consider carefully all the possible risks, and ways in which the equipment
(preferably) or the methodology can be adapted to eliminate the hazards
How to analysis risk
Definitions
Hazard:
The potential for harm.
Risk:
The probability (or likelihood) of harm actually occurring and the severity of its
consequences
Risk Assessment:
The process of deciding on actions to be taken to reduce risk to an acceptable
level by implementing control measures.
Hazards identified:
List all potential hazards, e.g. those that may arise from substances, electricity, equipment
or machines and the ways in which people use or misuse those items etc.
Control measures:
These are things you will be putting in place to reduce risks to their lowest level.
Revision date: 14 Jan 2015
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Risk matrix (to determine risk priority)
Found a hazard? Think about:
How severely could it hurt someone?
How likely is it to hurt someone?
!!! kill or disable
!! several days
off work
! first aid
very likely ++
could happen regularly
1
2
3
likely +
could happen occasionally
2
3
4
unlikely could happen, but only rarely
3
4
5
very unlikely -could happen, but probably never
will
4
5
6
Risk priority:
1 to 2 = High Risk 3 to 4 = Moderate Risk
5 to 6 = Low Risk
Hierarchy of hazard control
1. Eliminate the hazard or task if the risks outweigh the potential benefits.
2. Substitute the hazard with something less hazardous eg., substitute a toxic
substance with another that is non-toxic.
3. Isolate the hazard by using barriers or distance eg., put insulation around noisy
equipment.
4. Use engineering controls, such as local exhaust ventilation to remove dust/fumes,
or automate the process.
5. Minimise the size or volume of the hazard and the duration of exposure to the
hazard.
6. Rearrange the work area and work flow eg., have deliveries made to the end-point
to avoid re-handling, intersperse repetitive activity with different tasks to avoid
overuse injuries etc.
7. Establish safe work practices, such as restricting access to the area, keeping the
area free of clutter, being prepared for emergencies e.g., spills, and prepare and
use safe work method statements for hazardous tasks.
8. Provide training and supervision appropriate to the level of expertise of the
personnel involved. As a minimum, this would include familiarisation with local
hazards and their control, safe work methods and emergency procedures.
9. Wear personal protective equipment such as robust footwear, gloves, laboratory
coats, safety glasses, ear plugs/muffs, dust masks etc., as a secondary measure to
supplement the other agreed risk controls.
Revision date: 14 Jan 2015
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PART 4.
STANDARD OPERATING PROCEDURE
Describe Standard Operating Procedure and insert block schematic Diagram indicating
voltage / current levels. Insert a Process Flow Diagram (if appropriate)
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Revision date: 14 Jan 2015
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PART 5.
GENERAL SAFETY INFORMATION
Personal Protection Equipment (PPE)
Lab Coat
☐Yes
☐No
Gloves
☐Yes
☐No
Face Mask
☐Yes
☐No
Ear Protection
☐Yes
☐No
Eye Protection
☐Yes
☐No
Foot Protection
All Laboratories
Special Monitoring (Hearing test, Eye test, Dust exposure etc).
Is special monitoring required?
☐Yes
☐No
Details:
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Waste Disposal Substances hazardous to health Information from MSDS as to disposal
requirements
Is Hazardous waste likely?
☐Yes
☐No
Waste Disposal Procedures:
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First Aid
First aid procedures in event of accident?
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Action required in the event of Equipment Failure
Any special notification needed?
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Out of Hours Emergency Shut Down Procedure
Any special procedural document must be kept Click here to enter text.
near to experimental machine.
ALWAYS THINK SAFETY
Revision date: 14 Jan 2015
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PART 6.
DECLARATION
Are there any changes in this application from the previous submission?
☐ Yes
☐ No
☐ First submission
I have understood and completed this form to accurately assess the WHS risks associated
with my activity at the School of Electrical and Information Engineering.
Name of Staff/Student:
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Signature:
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Date:
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I have understood this form and accurately assess the WHS risks associated with my
staff/student’s research activity at the School of Electrical and Information Engineering.
Name of Supervisor:
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Signature:
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Date:
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Revision date: 14 Jan 2015
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WORK PERMIT
ROOMS/LABS:
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APPLICATION NO.:
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PROJECT TITLE:
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STAFF/STUDENT’S NAME:
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STAFF/STUDENT ID:
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SUPERVISOR’S NAME:
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PROJECT SAFETY CLASSIFICATION:
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CONDITIONS PERMITTED
DURING NORMAL WORKING HOURS
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Name of Chair
Phone number
S. Sathiakumar
9351 4640
Name of Dept. Officer
Phone number
T. Huang
9351 2657
Revision date: 14 Jan 2015
CONDITIONS PERMITTED AFTER
HOURS
(ONLY ACTIVITIES WITH HAZARD
RATING OF 5-6 ARE ALLOWED FOR
AFTER HOURS ACCESS)
Signature
Date
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enter a date.
Signature
Date
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enter a date.
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