Workplace TMP Risk Assessment Form
Biểu mẫu - Version 1
Workplace TMP Risk Assessment Form · FORM-31665
- Risk Assessment No.
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- Location
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- No. of workers at the workplace
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- Address
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- Contact Name
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- Position
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- Phone No.
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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
| 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 |
Scope of Traffic Management Risk Assessment
PPE
Assessment and approval
- Name of Assessor
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- Signature
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- Job Title
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- Date
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- Names of people consulted with during development of this Risk Assessment
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- Signature/s
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- Job Title
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- Date
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- Person Responsible for ensuring compliance with Risk Assessment
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- Signature
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- Job Title
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- Date
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- Risk Assessment Approved by
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- Signature
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- Job Title
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- Date
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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
Traffic management hazard – Other
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Workplace TMP Risk Assessment Form · FORM-31665
