Plant Risk Assessment Form
Form - Version 4
Plant Risk Assessment Form · FORM-30112
- RAF #
- —
- Date
- —
- Business name
- [Company]
- Business address
- —
- ABN
- —
- Business contact
- —
- Position
- —
- 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 #
- —
- Capacity/size
- —
- Plant licence no.
- —
- Valid to
- —
Operator licence / competency
- External licence (specify)
- —
- Registration #
- —
- Internal competency (specify)
- —
- Valid to
- —
- Other (specify)
- —
Overall risk rating after controls
Determine the risk score
| Consequence → | |||||
|---|---|---|---|---|---|
| Likelihood ↑ | InsignificantNo injury | MinorFirst aid | ModerateMedical treatment, time off work | MajorSerious injury, hospital | CatastrophicDeath or permanent disability |
| Almost certainExpected to happen | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| LikelyWill probably happen | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute | 4 A4 Acute |
| PossibleMight happen now and then | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| UnlikelyCould happen at some time | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 3 H3 High | 4 A4 Acute |
| RareOnly in exceptional circumstances | 1 L1 Low | 1 L1 Low | 2 M2 Moderate | 2 M2 Moderate | 3 H3 High |
- 1 L1 LowManage with routine procedures.
- 2 M2 ModerateGo ahead with care: supervise and check the controls.
- 3 H3 HighReduce the risk before work starts; a supervisor checks the controls.
- 4 A4 AcuteStop: work must not start until the risk is reduced.
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
- —
Its guidance and example entries are locked
You can see how the form is laid out. Get it to fill in on any device, print it, or make it your own.
Plant Risk Assessment Form · FORM-30112




