Health Safety Risk Assessment Template

Risk Assessment Template
Use this template to document a risk assessment to manage health and safety hazards and risks.
For more details on the risk management process refer to, Managing Health and Safety Risks.
Note: For risk assessments with curriculum activities refer to: Managing Risks in School Curriculum Activities.
Activity Description:
Conducted by:
Date:
Step 1: Identify the Hazards

Biological
(e.g. hygiene, disease, infection)
Blood / Bodily fluid

Other/Details:
Chemicals
Virus / Disease
Food handling
Note: Refer to the label and Safety Data Sheet (SDS) for the classification and management of all chemicals.
Non-hazardous chemical(s)
Name of chemical(s) / Details:
Hazardous chemical (Refer to a completed hazardous chemical risk assessment)
Critical Incident resulting in:

Lockdown
Other/Details:
Evacuation
Disruption
Energy Systems incident / issues involving:

Electricity (incl. Mains and Solar)
Other/Details:
LPG Gas
Gas / Pressurised containers
Environment
Sun exposure
Animals / Insects
Other/Details:
Water (creek, river, beach, dam)
Sound / Noise
Storms / Weather
Temperature (heat, cold)
Driveway / Paths
Workshops / Work rooms
Furniture
Swimming pool
Machinery (portable)
Hand tools
Working at heights
Restricted space
Staff
Parents / Others
Facilities / Built Environment

Buildings and fixtures
Playground equipment
Other/Details:
Machinery, Plant and Equipment
Machinery (fixed plant)
Vehicles / trailers
Other/Details:
Manual Tasks / Ergonomics
Manual tasks (repetitive, heavy)
Other/Details:
People
Students
Physical
Other/Details:
Psychological / Stress
Other Hazards / Details
Organisational Health
Department of Education, Training and Employment
Issued: August 2012

Uncontrolled when printed
Page 1 of 4
Step 2: Assess the Level of Risk

Consider the hazards identified in Step One and use the risk assessment matrix below as a guide to assess the
risk level.
Consequence
Likelihood
Insignificant
Minor
Moderate
Major
Critical
Medium
Medium
High
Extreme
Extreme
Likely
Low
Medium
High
High
Extreme
Possible
Low
Medium
High
High
High
Unlikely
Low
Low
Medium
Medium
High
Rare
Low
Low
Low
Low
Medium
Almost Certain
Consequence
Description of Consequence
Likelihood
Description of Likelihood
1. Insignificant
No treatment required
1. Rare
Will only occur in exceptional circumstances
2. Minor
Minor injury requiring First Aid treatment

(e.g. minor cuts, bruises, bumps)
2. Unlikely
Not likely to occur within the foreseeable

future, or within the project lifecycle
3. Moderate
Injury requiring medical treatment or lost

time
3. Possible
May occur within the foreseeable future, or

within the project lifecycle
4. Major
Serious injury (injuries) requiring specialist

medical treatment or hospitalisation
4. Likely
Likely to occur within the foreseeable future,

or within the project lifecycle
5. Critical
Loss of life, permanent disability or multiple

serious injuries
5. Almost
Certain
Almost certain to occur within the foreseeable

future or within the project lifecycle
Assessed Risk Level
Description of Risk Level
Actions
Low
If an incident were to occur, there would be little

likelihood that an injury would result.
Undertake the activity with the existing

controls in place.
Medium
If an incident were to occur, there would be some chance

that an injury requiring First Aid would result.
Additional controls may be needed.
High
If an incident were to occur, it would be likely that an

injury requiring medical treatment would result.
Controls will need to be in place before the

activity is undertaken.
Extreme
If an incident were to occur, it would be likely that a

permanent, debilitating injury or death would result.
Consider alternatives to doing the activity.

Significant control measures will need to be
implemented to ensure safety.
Step 3: Control the Risk

In the table below:
1. List below the hazards/risks you identified in Step One.
2. Rate their risk level (refer to information contained in Step Two to assist with this).
3. Detail the control measures you will implement to eliminate or minimise the risk.
Note: Control measures should be implemented in accordance with the preferred hierarchy of control. If lower
level controls (such as Administration or PPE) are to be implemented without higher level controls, it is
important that the reasons are explained.
Hierarchy of Control
Most effective
(High level)
Elimination: remove the hazard completely from the workplace or activity

Substitution: replace a hazard with a less dangerous one (e.g. a less hazardous chemical)
Redesign: making a machine or work process safer (e.g. raise a bench to reduce bending)
Isolation: separate people from the hazard (e.g. safety barrier)
Least effective
(Low level)
Administration: putting rules, signage or training in place to make a workplace safer

(e.g. induction training, highlighting trip hazards)
Personal Protective Equipment (PPE): Protective clothing and equipment (e.g. gloves, hats)
Issued: August 2012

Page 2 of 4
Hazards/Risks and Control Measures

1. Description of
Hazards / Risks
2. Risk
Level
4. Control Measures
(Note: if only Administration or PPE controls are used, please explain why.)
Other details:
Issued: August 2012

Page 3 of 4
Submission
This activity will be conducted in accordance with this risk assessment, implementing the control measures outlined in
Step Three. Changes will be made to the activity, if required, to manage any emerging risks to ensure safety.
Contact person:
Date:
Indicate those others involved in the preparation of this risk assessment.
Step 4: Monitor and Review Controls

Complete during and/or after the activity.
Yes
No
1. Are the planned control measures sufficient and effective in minimising the level of risk?
2. Have there been any changes to the planned control measures?
3. Are further control measures required in future?
Details:
Review completed by:
Designation:
Signature:
Date:
Issued: August 2012

Page 4 of 4

Health Safety Risk Assessment Template

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Risk Assessment Template

Step 1: Identify the Hazards

(e.g. hygiene, disease, infection)

Blood / Bodily fluid

Hazardous chemical (Refer to a completed hazardous chemical risk assessment)

Critical Incident resulting in:

Energy Systems incident / issues involving:

Gas / Pressurised containers

Water (creek, river, beach, dam)

Temperature (heat, cold)

Workshops / Work rooms

Facilities / Built Environment

Other Hazards / Details

Issued: August 2012

Step 2: Assess the Level of Risk

Will only occur in exceptional circumstances

Minor injury requiring First Aid treatment

Not likely to occur within the foreseeable

Injury requiring medical treatment or lost

May occur within the foreseeable future, or

Serious injury (injuries) requiring specialist

Likely to occur within the foreseeable future,

Loss of life, permanent disability or multiple

Almost certain to occur within the foreseeable

Assessed Risk Level

Description of Risk Level

If an incident were to occur, there would be little

Undertake the activity with the existing

If an incident were to occur, there would be some chance

Additional controls may be needed.

If an incident were to occur, it would be likely that an

Controls will need to be in place before the

If an incident were to occur, it would be likely that a

Consider alternatives to doing the activity.

Step 3: Control the Risk

Elimination: remove the hazard completely from the workplace or activity

Administration: putting rules, signage or training in place to make a workplace safer

Issued: August 2012

Hazards/Risks and Control Measures

Issued: August 2012

Indicate those others involved in the preparation of this risk assessment.

Step 4: Monitor and Review Controls

Review completed by:

Issued: August 2012

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