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
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- Risk Assessment No.
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- Risk Assessment Approved by
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- Name/Signature
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- Company Name
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- 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
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- No. of workers at the workplace
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- Specify
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- Specify
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- Assessor Name / Signature
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- Job Title
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- Date
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- Names of workers consulted with during development of this Risk Assessment / Signature/s
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- Job Title/s
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- Date
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- Person Responsible for ensuring compliance with Risk Assessment / Signature
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- Job Title
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- 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 |
|---|---|---|---|---|
| - | - | - | - | - |
| - | - | - | - | - |
| - | - | - | - | - |
Asbestos Risk Assessment Form · FORM-31265
