Asbestos Risk Assessment Form
Asbestos Risk Assessment Form · FORM-31265
Risk Assessment Form Guidance Sheet
Stage 1. Introduction.
Stage 2. Hazard Identification.
Stage 3. Risk Control.
Stage 4. Monitor and review.
Summary - Key Outcomes:
Risk Rating Matrix
Step 1: Determine Likelihood: What is the possibility that the effect will occur?
Likelihood | Criteria | Description |
|---|---|---|
Step 2: Determine Consequence: What will be the expected effect?
Level of Effect | Example of each level |
|---|---|
Step 3: 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.
Step 4: Record risk score on the worksheet
Score | Action |
|---|---|
Hierarchy of control
Asbestos Risk Assessment Form
- Activity
- —
- Risk Assessment No.
- —
- Risk Assessment Approved by
- —
- Name/Signature
- —
- Company Name
- —
- Address
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- ABN
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- Contact Name
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- Position
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- Phone No.
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- Job Title
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- Date
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Personal protective equipment
Workplace Details
- Location
- —
- No. of workers at the workplace
- —
- Specify
- —
- Specify
- —
- Assessor Name / Signature
- —
- Job Title
- —
- Date
- —
- Names of workers consulted with during development of this Risk Assessment / Signature/s
- —
- Job Title/s
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- Date
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- Person Responsible for ensuring compliance with Risk Assessment / Signature
- —
- Job Title
- —
- Date
- —
Hazards and Control Measures
- Work activity
Working with asbestos (Examples only)
Competent person, site information, the Asbestos Register and notes for future reference.
- Work activity
Unauthorised access (Examples only)
Barriers, warning signage, no-go zones and distance from the asbestos location.
- Work activity
Transport ACM (Examples only)
Identifying, wrapping, labelling and bins for transporting asbestos-containing material.
- Work activity
De-contamination (Examples only)
Cleaning facilities, restricted access, airlocks, water run-off filters and the removal work area.
- Work activity
Wearing PPE during the task
PPE to wear at the loading site, including a P1 or P2 half-face respirator.
Monitor & Review
- Person/s Responsible
- —
- Signature/s & Date
- —
Review Record
Review Date | Review conducted by | Signature/s | Next review due |
|---|---|---|---|
Worker Sign-Off & Acknowledgement
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 | Date | Signature |
|---|---|---|---|---|
| - | - | - | - | - |
| - | - | - | - | - |
| - | - | - | - | - |
Thêm 5 bước công việc, từ Working with asbestos (Examples only) đến Wearing PPE during the task
Mỗi bước đều có mối nguy, mức rủi ro và biện pháp kiểm soát, cùng phần ký nhận của đội.
Asbestos Risk Assessment Form · FORM-31265
