WHS Risk Assessment Form

WHS Risk Assessment Form
This form is to be used for all Crew Members for assessing risks when:
 Undertaking a task that has not been done before
 A hazard has been identified
 There is a change in the workplace to the work equipment, practices, procedures or
environment
 Responding to a workplace incident, even where an injury has not occurred
 New information about a risk becomes available or concerns about a risk are raised by Crew
 Regular risk assessments are scheduled
 Following a WHS hazard inspection and risks are to be assessed
Important note: Any serious illness or injury must be reported to a Plan2go Director immediately.
ASSESSOR INFORMATION
Name/s of assessor/s: Sanchita Buma
Date of assessment: 23/12/19
Department: Project Office
Risk assessment name: Manual handling
Form completed by: Sumnima Pandey
Signature: Date: 23/12/19
Line Manager/HSR: Todd Harris
Signature: Date: 23/01/20
RISK ASSESSMENT
Identify the activity and the location of the activity/task/situation.
Plan2go: WHS Risk Assessment Form [ 1 ]
Created: 10-05-2009 | Last Updated 31/08/2024

Description of activity:
Lifting more than 10 kg
Description of location:
Production line
Identify who may be at risk from the activity/task/situation.
Person/s at risk:
Employee may receive back and other injuries if correct practices are not adhered to .
How they were consulted on the risk
Consultation with workers and their health safety representative
List legislation, standards, codes of practice, manufacturer’s guidance, etc. used to
determine control measures necessary.
Work Health and Safety Act 2011
Work Health and Safety Regulation 2011
Work Safety Act January 1, 2012
Work Safe Act 2011
Scaffolding and lifts Act 1912
Machinery Act 1949
Dangerous Goods Act 2009
Employment Standard Act 2000
Health and Welfare at Work Act 2005
Occupational Safety and Health Act 1970
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Plan2go: WHS Risk Assessment Form [ 2 ]
Created: 10-05-2009 | Last Updated 31/08/2024

IDENTIFY HAZARDS AND CONTROL THE RISKS
1. An activity may be divided into tasks. For each task identify the hazards and associated
risks. Also list the possible scenarios which could sooner or later cause harm.
2. Determine controls necessary based on legislation, codes of practice, Australian standards,
manufacturer’s instructions as per the WHS Risk Assessment Procedure.
3. List existing risk controls and any additional controls that need to be implemented.
4. Rate the risk once all controls are in place using the risk matrix found in the WHS Risk
Assessment Procedure.
NOTE: If you need to determine whether it’s reasonably practicable to implement a control,
based on the risk complete the shaded blue columns. Feel free to resize the boxes to suit your
situation/the amount of text you need to use.
Task/Scenario Hazard Associat
ed
risks
Existing
controls
Risk
Rating Any
additional
controls
required?
Cost of
controls
(in terms
of time,
effort,
money)
Is this
reason
ably
practic
able?
Yes/No
S M L
Yes/No
Arranging meetings
where health and
safety measures
that are associated
with workplace are
clearly determined
Hazards
from the
part of
stress
associated
with
workplace
Some
employe
es may
be least
intereste
d in the
respecti
ve part.
Activel
y
partici
pating
in
workpl
ace
inspect
ions.
No Yes
Yes/No
Acting as a safety
and health
consultation
representative
Problems
associated
with
chemicals
in the
organizati
on that are
hazardous.
Not all
initiative
s made
can be
systemat
ically
impleme
nted
Consul
ting
with
other
workin
g team
memb
ers.
S No No
Yes/No
Arranging
membership
systems that are
related to safety
and health
consultation groups
Diseases
related to
occupation
can be the
other
major
cause.
Member
ship may
be made
available
to key
employe
es
Partici
pating
in
activiti
es that
are
associa
No Yes
Plan2go: WHS Risk Assessment Form [ 3 ]
Created: 10-05-2009 | Last Updated 31/08/2024

excludin
g others
ted
with
genera
l
housek
eeping
in
work
area.
Yes/No
It is important to
make certain
recommendations
that are associated
with the goals of the
organization under
the area of creating
a safe working
environment which
must be related to
the terms and
procedures of the
company
Any kind
of other
psychologi
cal stress
issues
within the
organizati
on.
All plans
and
initiative
made
may not
connect
with the
terms
and
conditio
ns of the
organiza
tion
Imple
mentin
g risk
control
plans
accord
ing to
the
terms
and
proced
ures of
the
organi
zation.
M No Yes
List emergency procedures and controls if applicable
List emergency controls for how to deal with fires, spills or exposure to hazardous
substances and/or emergency shutdown procedures:
Through the process of raising an alarm signal
Informing the fire service
Turning off any hazardous machinery in workplace
By ensuring not entering the building again.
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Implementation
Additional control measures needed:
Setting fire extinguishers at every floor.
Arranging alarm signals for urgent purpose
Installing building map in every floor so that employees can get out safely.
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Resources required:
Fire Extinguishers
Plan2go: WHS Risk Assessment Form [ 4 ]
Created: 10-05-2009 | Last Updated 31/08/2024

Fire Alarms.
Building maps.
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Responsible
person:
Maintenance
Authority
Administrati
ve Authority.
Securities
controlling
cctv.
[Name] Date of
implementation
:
28/12/19
Plan2go: WHS Risk Assessment Form [ 5 ]
Created: 10-05-2009 | Last Updated 31/08/2024

REVIEW
Scheduled review date: 30/12/19
Are all control measures in place?
yes
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Are controls eliminating or minimising the risk?
yes
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Are there any new problems with the risk?
no
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Review by:
Administra
tive
Authority
of the
building
[Name] Review date: 31/12/19
Acknowledgement of understanding
All persons performing these tasks must sign that they have read and understood the risk
assessment procedure (as described in the WHS Risk assessment procedure).
I have read and understand this WHS Risk Assessment Form:
Name: [Name]
Signature: Date: [Click here to
enter the date]
Name: [Name]
Signature: Date: [Click here to
enter the date]
Name: [Name]
Signature: Date: [Click here to
enter the date]
Plan2go: WHS Risk Assessment Form [ 6 ]
Created: 10-05-2009 | Last Updated 31/08/2024

Plan2go: WHS Risk Assessment Form [ 7 ]
Created: 10-05-2009 | Last Updated 31/08/2024