टेम्प्लेट कागजातहरू अंग्रेजीमा लेखिएका छन्।

Workplace Violence Risk Assessment Form

फारम · FORM-31127

संस्करण 2
Miscellaneous
जुनसुकै फोनमा पढ्न मिल्छ

The Workplace Violence Risk Assessment Form is used when looking at situations that may expose a worker to a violent situation. It helps businesses implement effective safety control measures to protect their workers from violent situations.

It records the workplace details and overall risk rating, then works through prior incidents, staff management, work location, facilities management, road use, working with cash and working with clients, customers or members of the public, each with example control measures to use or replace. A guidance sheet, risk matrix and hierarchy of controls support it.

Suitable for workplace managers, safety officers, HR professionals, supervisors and contractors.

Workplace Violence Risk Assessment Form

फारमVersion 2

Guidance Sheet for Workplace Violence Risk Assessment Form

Stage 1. Introduction.

Stage 2. Hazard Identification.

Stage 3. Risk Control.

Stage 4. Monitor and review.

Summary - Key Outcomes:

Workplace Violence Risk Assessment – Part 1

Risk Assessment No.: —
Risk Assessment Approved by: Name/Signature: —
Company Name: [Company]
Address: —
ABN: —

Contact Name: —
Position: —
Phone No.: —
Job Title: —
Date: —

Workplace Details

Location: —

No. of workers at the workplace: —

Specify (remote work): —

Specify (isolated work): —

Specify (outdoors): —
Specify (indoors): —

Specify (off-site): —

Assessor Name / Signature: —
Assessor Job Title: —
Assessor Date: —
Names of workers consulted with during development of this Risk Assessment / Signature/s: —
Job Title/s: —

Workers Date: —
Person Responsible for ensuring compliance with Risk Assessment / Signature: —
Person Responsible Job Title: —
Person Responsible Date: —

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.

Hierarchy of Controls

Exposure To Violence Hazard Factors				Control measures in place		Person/s Responsible
Prior Incidents




Staff Management

Workplace Violence Risk Assessment – Part 2

Monitor & Review: Person/s Responsible: —

Monitor & Review: Signature/s & Date: —

Review Record

Review Date	Review conducted by	Signature/s	Next review due

Workplace Violence Risk Assessment – Part 3

This Risk Assessment has been developed in consultation and cooperation with workers and the Organisation. I have read the above Risk Assessment, and I understand its contents. I confirm that I have the skills and training, including relevant certification, to conduct the task as described. I agree to comply with safety requirements within this Risk Assessment, including risk control measures, safe work instructions and management direction.

Worker’s name	Job role / positione.g. supervisor, worker, trainee	Company	Licences, competencies & qualificationsType / descriptionClassNumber	Date	Signature
-	-	-	-	-	-
-	-	-	-	-	-
-	-	-	-	-	-

यसको मार्गदर्शन र नमुना प्रविष्टिहरू लक गरिएका छन्

फारमको बनावट कस्तो छ तपाईं देख्न सक्नुहुन्छ। जुनसुकै डिभाइसमा भर्न, प्रिन्ट गर्न वा आफ्नो बनाउन यो लिनुहोस्।

एडिटर निःशुल्क चलाएर हेर्नुहोस्यो टेम्प्लेट लिनुहोस्

ब्राउजरमा यो कस्तो देखिन्छ

यो टेम्प्लेट लिनुहोस्

निःशुल्क साइन अप गर्नुहोस्, अनि कसरी लिने छान्नुहोस्। तपाईंको कम्पनीको विवरण आफैँ भरिन्छ।

सशुल्क प्लानहरूमा समावेश
आफ्नो प्लानका टेम्प्लेट क्रेडिट प्रयोग गर्नुहोस्। यसको मूल्य 1 हो।
प्लान र मूल्य तुलना गर्नुहोस्
एकपटक किन्नुहोस्
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एडिटर निःशुल्क चलाएर हेर्नुहोस्निःशुल्क साइन अप गर्नुहोस्

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यसले के समेट्छ

39 फिल्ड

Risk Assessment No
Risk Assessment Approved by: Name/Signature
Company Name
Address
ABN
Contact Name
Position
Phone No
Job Title
Date
Location
No. of workers at the workplace

र थप 27

समीक्षाहरू

अहिलेसम्म कुनै समीक्षा छैन।

यो कामका लागि गाइडहरू

Workplace violence: creating a safe work environmentHow to manage workplace violence and aggression under WHS laws, from what counts and who is exposed to the policies, training and response steps that work.गाइड पढ्नुहोस्

सबै हेर्नुहोस्

Legislation and Codes of Practice Reference List

नीति · POLICY-31105

4 खण्ड4.8(5)

पूर्वावलोकन चलाएर हेर्नुहोस्

Manual Handling

SWMS · SWMS-10168

कामका 18 चरण

पूर्वावलोकन चलाएर हेर्नुहोस्

Welding

SWMS · SWMS-10136

कामका 10 चरण

पूर्वावलोकन चलाएर हेर्नुहोस्

JSEA Template

फारम · FORM-30010

8 फिल्ड4.4(5)

पूर्वावलोकन चलाएर हेर्नुहोस्

टेम्प्लेटहरू कसरी काम गर्छन्

यसलाई पैसा तिर्नुअघि नै चलाएर हेर्नुहोस्।

निःशुल्क पूर्वावलोकन
हरेक टेम्प्लेटका कामका चरण, खतरा र पहिलो काम पढ्न खुला छन्। साइन अप चाहिँदैन।
एडिटर चलाएर हेर्नुहोस्
कम्प्युटर वा फोनमा, डेमो SWMS लाई आफ्नो कम्पनी, काम र साइटअनुसार मिलाउनुहोस्।
निःशुल्क साइन अप गर्नुहोस्
तपाईंको विवरण र लोगो सर्छन्। यो टेम्प्लेट विवरण भरिएरै खुल्छ।
क्रेडिट प्रयोग गर्नुहोस् वा एकपटक किन्नुहोस्
सशुल्क प्लानहरूमा हरेक महिना टेम्प्लेट क्रेडिट आउँछ। वा सधैँका लागि यो एउटा किन्नुहोस्।

Workplace Violence Risk Assessment Form