Risk Assessment Document

This template is to be used with reference to the OHS Risk Management Procedure. For support in conducting a Risk Assessment contact the EHS
Engineer-Ebron Jeyaseelan

1. Background Information
Workplace: Date:
Title of Name of
Assessment: person
conducting
assessment:

2. Risk Assessment
List Additional Controls (if any - where current controls
Identify and list Hazards List Current Risk Controls Risk Rating
are not adequately managing the level of risk)
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 Risk Assessment Template

2. Risk Assessment
List Additional Controls (if any - where current controls
Identify and list Hazards List Current Risk Controls Risk Rating
are not adequately managing the level of risk)
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1. Consequence - Evaluate the consequences of a risk occurring according to 2. Likelihood - Evaluate the likelihood of an incident occurring according to the
the ratings in the top row ratings in the left hand column

Descriptor Level Definition Descriptor Level Definition

Insignificant 1 No injury
Rare 1 May occur somewhere, sometime (“once in a life time /
Minor 2 Injury/ ill health requiring first aid once in a hundred years”)

Moderate 3 Injury/ill health requiring medical Unlikely 2 May occur somewhere within the Department over an
attention extended period of time

Major 4 Injury/ill health requiring hospital Possible 3 May occur several times across the Department or a
admission region over a period of time

Severe 5 Fatality Likely 4 May be anticipated multiple times over a period of time
May occur once every few repetitions of the activity or
event
3. Risk Matrix – Using the matrix calculate the level of risk by finding the
Almost 5 Prone to occur regularly
intersection between the likelihood and the consequences
Certain It is anticipated for each repetition of the activity of event
Likelihood Consequence
4. Risk Level/Rating and Actions
Insignificant Minor Moderate Major Severe
Descripto Definition
Almost Medium High Extreme Extreme Extreme r
Certain
Likely Medium Medium High Extreme Extreme Extreme: Notify Workplace Manager and/or Management OHS
Nominee immediately. Corrective actions should be taken
Possible Low Medium Medium High Extreme immediately. Cease associated activity.
High: Notify Workplace Manager and/or Management OHS
Unlikely Low Low Medium Medium High Nominee immediately. Corrective actions should be taken
within 48 hours of notification.
Rare Low Low Low Medium Medium Medium: Notify Nominated employee, HSR / HSC. Nominated
employee, OHS Representative / HSC is to follow up that
corrective action is taken within 7 days.
Low Notify Nominated employee, HSR / HSC. Nominated
employee, HSR / HSC is to follow up that corrective action is
taken within a reasonable time.
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