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:
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
Plan2go: WHS Risk Assessment Form [ 1 ]
Created: 10-05-2009 | Last Updated 5/09/2022

Identify the activity and the location of the activity/task/situation.
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
[Click here to enter text]
Plan2go: WHS Risk Assessment Form [ 2 ]
Created: 10-05-2009 | Last Updated 5/09/2022

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 Associ
ated
risks
Existin
g
control
s
Risk
Rating Any
additional
controls
required?
Cost of
controls
(in
terms of
time,
effort,
money)
Is this
reaso
nably
practi
cable?
Yes/N
o
S M L
Arranging
meetings where
health and
safety measures
that are
associated with
workplace are
clearly
determined
Hazards
from the
part of
stress
associate
d with
workplac
e
Some
employ
ees
may be
least
interes
ted in
the
respect
ive
part.
Activ
ely
partic
ipatin
g in
work
place
inspe
ctions
.
No
Acting as a
safety and
health
consultation
representative
Problems
associate
d with
chemical
s in the
organizat
ion that
are
hazardou
s.
Not all
initiativ
es
made
can be
system
atically
implem
ented
Cons
ulting
with
other
worki
ng
team
mem
bers.
S No
Plan2go: WHS Risk Assessment Form [ 3 ]
Created: 10-05-2009 | Last Updated 5/09/2022