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Workplace TMP Risk Assessment Form

Formulario · FORM-31665

Versión 1
Transport & Warehousing
Se lee en cualquier teléfono

The Workplace TMP Risk Assessment Form helps you assess the risks in a workplace traffic management plan. It walks through the likelihood, consequence and risk score steps, with a hierarchy of controls.

It covers the scope of the assessment and higher risk conditions such as forklifts, heavy vehicles and blind corners, the personal protective equipment required, and the monitor and review arrangements.

It then sets out traffic hazards with their causes and example control measures: site traffic, planning, noise, lighting, struck or crushing, plant and vehicle condition, operator training and communication systems.

Workplace TMP Risk Assessment Form

FormularioVersion 1

Risk Assessment No.: —
Location: —
No. of workers at the workplace: —
Address: —

Contact Name: —
Position: —
Phone No.: —
Email: —

Step 1: Determine likelihood

	Criteria	Description
Almost certain
Likely
Possible
Unlikely
Rare

Step 2: Determine consequence

Level of Effect:	Example of each level:
Insignificant/ Acceptable
Minor
Moderate
Major
Catastrophic

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 on the worksheet

Score	Action

Scope of Traffic Management Risk Assessment

PPE

Assessment and approval

Name of Assessor: —
Signature: —

Job Title: —
Date: —

Names of people consulted with during development of this Risk Assessment: —
Signature/s: —

Job Title: —
Date: —

Person Responsible for ensuring compliance with Risk Assessment: —
Signature: —

Job Title: —
Date: —

Risk Assessment Approved by: —
Signature: —

Job Title: —
Date: —

Monitor and review


Name
Initial
Date

Hazards and control measures

Site traffic hazard

Site traffic hazard - Planning

Traffic management hazard - Noise hazard

Traffic management hazard - Lighting

Traffic management hazard – Struck/crushing

Hazard – Plant/vehicle condition

Hazard – Operator training/qualifications

Traffic management hazard – communication systems

Traffic management hazard – Other

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Risk Assessment No
Location
No. of workers at the workplace
Address
Contact Name
Position
Phone No
Email
Criteria
Description
Almost certain
Likely

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