WHS Risk Assessment Form
(Title of assessment)
Date of assessment
Program
Location
Process or task assessed
Reason for the assessment
Assessment team:
(manager/team leader, HSR,
WHS consultant, etc)
Writer of the report
Please ensure that you share this risk assessment with your WHS Committee
Summary of key recommendations
Introduction – Provide a brief introduction to the process or task
Method - How was the assessment conducted?
Findings – What did you observe or find? What does this mean in terms of risk?
Document number
WHS-301.5, WHS Risk Assessment Form
Date
17 May 2012
Page number
1 of 3
Authorised by
Director Human Resources
Risk assessment
Risk description
Existing controls
Exposure, likelihood,
consequence = current risk
rating
Risk description:
New controls required (base
these on the hierarchy of
controls)
1. Eliminate the risk
2. Substitute the risk
3. Engineer a solution
4. Administrative controls
5. Personal protective
equipment
Residual risk
Exposure, likelihood,
consequence and risk rating
after new controls
Control options:
Exposure, likelihood,
consequence and risk rating after
new controls:
Existing controls:
Exposure (how much of the time are
people exposed to the risk):
Likelihood, consequence, current
risk:
Document number
WHS-301.5, WHS Risk Assessment Form
Date
17 May 2012
Page number
2 of 3
Authorised by
Director Human Resources
Person
responsible for
action
Due Date
Appendix 1 The Red Cross Risk Matrix and WHS hierarchy of controls
Team leader/
manager
Risk Matrix
HSR and Red
Cross people
LIKELIHOOD OF RISK
OCCURRING
IMPACT OF RISK
OCCURRING
Consultation
RARE
UNLIKELY
POSSIBLE
LIKELY
CERTAIN
1
2
3
4
5
Insignificant
Low Risk
Low Risk
Low Risk
Low Risk
Medium
Risk
Minor
Low Risk
Low Risk
Medium
Risk
Medium
Risk
High Risk
Medium
Risk
High Risk
Extreme
Risk
Moderate
Low Risk
Medium
Risk
Hazard identification
Risk assessment
Major
Low Risk
Medium
Risk
High Risk
Extreme
Risk
Extreme
Risk
Extreme
Medium
Risk
High Risk
Extreme
Risk
Extreme
Risk
Extreme
Risk
Eliminate the risk
Less effective
Substitute for a
lesser risk
Engineer a solution
Administrative*
PPE **
WHS-301.5, WHS Risk Assessment Form
Date
17 May 2012
Page number
3 of 3
Authorised by
Director Human Resources
* Procedures and
training
** Personal
protective equipment
Implement controls
Document number
Evaluate controls
Risk control