Plant Risk Assessment Form
Form - Version 4
Plant Risk Assessment Form · FORM-30112
- RAF #
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- Date
- —
- Business name
- [Company]
- Business address
- —
- ABN
- —
- Business contact
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- Position
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- Phone #
- —
- —
- Person/s responsible for ensuring compliance with RAF
- —
Workers consulted in the development, approval and communication of this RAF
Name | Job title | Signature | Date |
|---|---|---|---|
Plant details
- Brand
- —
- Model/year
- —
- Serial #
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- Capacity/size
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- Plant licence no.
- —
- Valid to
- —
Operator licence / competency
- External licence (specify)
- —
- Registration #
- —
- Internal competency (specify)
- —
- Valid to
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- Other (specify)
- —
Overall risk rating after controls
Determine the risk score
| Consequence → | |||||
|---|---|---|---|---|---|
| Likelihood ↑ | InsignificantNo effect, or so minor that the effect is acceptable | MinorMinor first aid treatment, minimal business disruption, minimal environmental effect | ModerateSerious injuries, medium business interruption, medium environmental impact | MajorExtensive injuries or fatality, significant business interruption, environmental harm, prosecution | CatastrophicMultiple permanent disabilities or fatalities, business failure, substantial environmental harm, prosecution or imprisonment |
| Almost certainExpected in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| LikelyWill probably occur in most circumstances | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| PossibleCould possibly occur at some time | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| UnlikelyUnlikely but possible | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| RareHighly unlikely to occur | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High |
- 1 L1 LowRecord and monitor. Proceed with work, and review the risks regularly.
- 2 M2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
- 3 H3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
- 4 A4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.
Score and action
Hierarchy of controls
Hazards and control measures
Entanglement
Crushing
Cuts, lacerations, stabbing, punctures
Shearing
Friction
Electrical
Explosion
Hazardous chemicals and hazardous atmosphere
Fluids or gases under pressure
Plant condition
Operator training/qualifications
Communication
Slip, trip and fall
Ergonomic
Temperature
Fire
Noise
Surrounding environment
Roll-away
Other
Review
Name | Initials | Date | |
|---|---|---|---|
Approval
- Name
- —
- Signature
- —
- Date
- —
- Comments
- —
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Plant Risk Assessment Form · FORM-30112
