Value pack · 19 templatesPart of Forms Kit

Risk Assessment Form

Form · FORM-30012

Version 6

The Risk Assessment Form helps identify and manage workplace hazards that may lead to an injury or illness. This form supports organisations in maintaining a safe working environment by systematically assessing risks and implementing control measures.

It includes a guide sheet with step-by-step instructions, a risk matrix to evaluate the likelihood and consequence of identified risks, and a table to record hazards, control measures, risk ratings and the person responsible.

Suitable for safety managers, OHS officers, HR professionals, business owners, construction supervisors and manufacturing leaders.

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Risk Assessment Form

FormVersion 6

Guide sheet

Name of Assessor: —
Date: —

Location: —
Review Date: —

Hazards Involved	Control Measure	Risk Rating	Person Responsible	Date Completed

Hierarchy of controls

Figure 1: Most Effective to Least Effective

Risk matrix

Step 1: Determine Likelihood

Step 2: Determine Consequence

Level of Effect	Example of each level

Step 3: Determine the risk score

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
	Consequence →
Almost certainExpected in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
LikelyWill probably occur in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
PossibleCould possibly occur at some time	1 Low	2 Moderate	2 Moderate	3 High	4 Acute
UnlikelyUnlikely but possible	1 Low	1 Low	2 Moderate	3 High	4 Acute
RareHighly unlikely to occur	1 Low	1 Low	2 Moderate	2 Moderate	3 High

1 LowRecord and monitor. Proceed with work, and review the risks regularly.
2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.

Step 4: Record risk

Score	Action

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What it covers

13 fields

Name of Assessor
Date
Location
Review Date
Hazards Involved
Control Measure
Risk Rating
Person Responsible
Date Completed
Level of Effect
Example of each level
Score

and 1 more

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Risk Assessment Form

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13 fields

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