WORK HEALTH AND SAFETY FORM

Topic WHS Risk Assessment

Section 1 – Activity Description Date of Assessment: Description of Activity/Hazard/Risk:

Work Site/Location: Assessment Conducted by: BACKGROUND INFORMATION Reason for Assessment:

Other Relevant Information:

PHOTOS/DIAGRAMS

Topic: WHS Risk Assessment Document Location: D:\Docs\2017-07-18\0c9967d07886fe06455f4dcaad942a62.doc Uncontrolled if Printed Page 1 of 5 Hazard  Hazard  Mechanical/Kinetic Chemicals/Substances Contact with moving plant/parts (cutting, shearing, entanglement, etc) Inhalation of dusts, gases, fumes, vapours and mists Contact with sharp objects/edges Ingestion of chemicals/substances Contact with moving vehicles/mobile plant Absorption of chemicals/substances through skin Struck by projectiles or ejected items (including struck in eye by object) Radiation Mechanical damage to services, PPE or other items Exposure to ionising radiation source (industrial radiography, non-destructive Gravitational testing) Fall from height Exposure to non-ionising radiation source (laser, welding flash, infrared, Falling object from height radiofrequency) Slips and trips Biological Access/work beneath a suspended load/unstable object Exposure to algal, bacterial, fungal, viral or parasitic agents (skin contact, Thermal and/or Explosive ingestion, inhalation) Fire/Explosion Animal, insect and spider bites/stings Ignition of gas/dust in a hazardous area Sharps/needle-stick exposure Contact with hot/cold objects/parts Manual Handling/Postural Excessively hot/cold environments (including heat stress) Handling heavy, unstable or awkward objects/loads Electrical Repetitious movements Contact with live electrical parts (overhead power line, etc) Maintaining static or awkward postures Exposure to high fault currents (within switchboards, battery banks) Tool use that requires excessive force Mechanical damage to power leads/fixed electrical wiring Psychological/Mental, Social, Medical Ingress of water into electrical components Working for excessive time periods and/or while fatigued Noise and/or Vibration Exposure to workplace bullying, harassment, violence Exposure to increased noise (levels that may cause hearing damage) Work Environment Contact with vibrating plant/vehicles/tools/objects Inadequate lighting Environmental Wet/slippery/uneven/unstable work surface Air/ground/water contamination (including spills, uncontrolled release, etc) Weather conditions (including flooding, lightning, wind) Release of harmful solid, liquid or gas during transport on/off site Working alone Incorrect waste disposal Unfavourable atmospheric conditions (dusty) Import of unauthorised soils, materials, plants or machinery Restricted access or working space Pressurised Other: Release of stored gas, liquid, solid under pressure Aviation: Release of spring/tension energy

Topic: WHS Risk Assessment Document Location: D:\Docs\2017-07-18\0c9967d07886fe06455f4dcaad942a62.doc Uncontrolled if Printed Page 2 of 5 Step 1 – Consider Consequences Step 2 – Consider Likelihood What are the consequences of the hazard occurring? Consider what is the most probable consequence (below) with What is the likelihood (below) of the hazard consequence respect to this work hazard in Step 1 occurring. Workplace Safety Legislative & Regulatory Serious breach of regulatory duty resulting in Could result in death, permanent total prosecutions against corporation and/or individuals or Almost Is expected to occur in most Extreme disabilities or severe injuries affecting Prohibition Notice issued against critical infrastructure Certain circumstances (once per month) multiple persons (operational impact) Could result in permanent partial disabilities Non-compliance with WHS legislation resulting in Will probably occur at least once Critical or injuries or illness resulting in notifiable incident or Prohibition Notice against non- Likely (between once per month and once per hospitalisation of multiple persons critical infrastructure (no major operational impact) year)

Could result in injury or illness LTI 5 shifts or Non-compliance with WHS legislation to which a penalty Might occur at some time (between once Major Possible more applies (fines, improvement notice etc) per year and once in 5 years)

Could result in injury or illness resulting in LTI Non-compliance with WHS legislation (excluding Could occur at some time (between once Moderate Unlikely (max 4 shifts) notifiable incidents in 5 years and once in 20 years)

Minor injury or illness not resulting in lost May occur in exceptional circumstances Minor Non-conformance with non-regulatory BAC requirement Rare work day (once in more than 20 years)

Step 3 – Calculate Risk

Consequences

Minor (5) Moderate (4) Major (3) Critical (2) Extreme (1)

1. Take Step 1 rating and select correct column Almost Certain Medium (A5) High (A4) Very High (A3) Very High (A2) Very High (A1) 2. Take Step 2 rating and select correct row (A) 3. Use the risk score where the two ratings cross on the matrix below Likely (B) Medium (B5) High (B4) High (B3) Very High (B2) Very High (B1) d o

VH = Very High o h i H = High l Possible (C) Low (C5) Medium (C4) Medium (C3) High (C2) Very High (C1) e k

M = Medium i L = Low L Unlikely (D) Low (D5) Low (D4) Medium (D3) Medium (D2) High (D1)

Rare (E) Low (E5) Low (E4) Low (E3) Medium (E2) High (E1)

Topic: WHS Risk Assessment Document Location: D:\Docs\2017-07-18\0c9967d07886fe06455f4dcaad942a62.doc Uncontrolled if Printed Page 3 of 5 Risk Analysis Control Measures Risk Analysis Additional Controls (with additional controls) Description of Hazard Description of Risk (Detail any existing (detail additional controls Risk Risk controls) C L to be implemented) C L Rating Rating   

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Topic: WHS Risk Assessment Document Location: D:\Docs\2017-07-18\0c9967d07886fe06455f4dcaad942a62.doc Uncontrolled if Printed Page 4 of 5 Section 4 – Risk Assessment Control / Action Timetable Required control and / or action Responsible Person Due Date

Decision of Acceptability of Risk (with ACCEPTABLE / NOT ACCEPTABLE above actions in place): Approved By: Name Signature

Comments:

Topic: WHS Risk Assessment Document Location: D:\Docs\2017-07-18\0c9967d07886fe06455f4dcaad942a62.doc Uncontrolled if Printed Page 5 of 5