PLANT - GENERAL RISK ASSESSMENT FORM

STEP 1 – ENTER INFORMATION ABOUT THE ACTIVITY/TASK, ITS LOCATION AND THE PEOPLE COMPLETING THE RISK ASSESSMENT RA NO.(If(IF
RA No. USED):
Used)

Location name: Building No.: Date: Assessed by: Health and Safety Rep.:

Users of the plant: Plant (Manufacturer’s name and model no):

Purpose of plant:

Description of how plant is used:

Does the operator require a licence or competency External licence Specify:

Internal competency Specify:

No specific competency

Workplace conditions (Describe layout and physical conditions - including access and egress)

Consider operation outside of normal conditions

• Cleaning • Non-standard use • Breakdown & repair
• Maintenance • Commissioning • Decommissioning
• Emergency situations
List systems of work for using the plant:
• Training procedure • SOPs
• Manufacturer’s information and instructions • Inspections

Is there past experience or background material regarding the plant operation that
may assist in the assessment
• Existing controls • SOPs • Standards
• Industry standards • Incidents & near-hits • Legislation & Codes
• Training • Incident Investigation • Uni guidance material

[Link] PLANT - GENERAL RISK ASSESSMENT FORM 1

Date: Version: Authorised by: Next Review:

Template date: 3 July 2012 Version:1.2 Authorised by: Director, OHS and Injury Management Next Review: 3 July 2015 © The University of Melbourne – Uncontrolled when printed.
STEP 2: SELECT A RISK RATING METHOD
TWO VARIABLE RISK MATRIX THREE VARIABLE RISK CALCULATOR

(1) Definition of likelihood label (1) Definition of exposure variable

Likelihood (Probability) Exposure E

Level Descriptor Description Expected to occur Continuously or many times daily 10

Frequently: Approximately once daily 6
A Almost certain The event will occur on an annual basis Once a year or more
Occasionally: Once a week to once a month 3
B Likely The event has occurred several times or more Once every three years
in your career Infrequently: Once a month to once a year 2

C Possible The event might occur once in your career Once every 10 years Rarely: Has been known to occur 1

D Unlikely The event does occur somewhere from time Once every 30 years Very rarely: Not known to have occurred 0.5
to time
(2) Definition of likelihood variable
E Rare Heard of something like the event occurring Once every 100 years
Likelihood L
elsewhere
Almost certain: The most likely outcome if the event occurs 10
(2) Definition of consequence label
Likely: Not unusual, perhaps 50-50 chance 6
Consequences types Unusual but possible: (e.g. 1 in 10) 3
Severity level Health and safety Natural environment Remotely possible: A possible coincidence (e.g. 1 in 100) 1
V Multiple fatalities, or significant irreversible Very serious, long-term environmental Conceivable: Has never happened in years of exposure, but possible (eg 1 in 1,000) 0.5
Catastrophe effects to >50 persons impairment of ecosystem functions
Practically impossible: Not to knowledge ever happened anywhere (e.g. 1 in 10,000) 0. 1
IV Single fatality and/or severe irreversible
disability (>30%) to one or more persons (3) Definition of consequences variable
Major
Consequences C
III Moderate irreversible disability or impairment Serious medium-term environment
(<30%) to one or more persons effects Catastrophe: Multiple fatalities, permanent extensive environmental damage 100
Moderate
Disaster: Fatality, permanent local, damage to environment 50
II Objective but reversible disability requiring Moderate, short-term effects but not
Insignificant hospitalisation affecting ecosystem functions Very serious: Permanent disability/ill health, non-permanent environmental damage 25
Serious: Non-permanent injury or ill health. Adverse effect on environment 15
I No medical treatment required Minor effects on biological or physical
Negligible environment Important: Medical attention needed, off-site emission but no damage 5

Adapted from HB 436: Risk management guidelines

Noticeable: Minor cuts and bruises or sickness, small loss of containment, no off-site 1
(3) Risk rating calculator
consequences

Likelihood Consequences label

(4) Risk Score Calculator
label I II III IV V
Risk Score = E x L x C
A Medium High High Very high Very high
Risk score Risk rating
B Medium Medium High High Very high > 600 Very high
C Low Medium High High High 300 - 599 High
D Low Low Medium Medium High 90 - 299 Medium
E Low Low Medium Medium High < 90 Low

[Link] PLANT - GENERAL RISK ASSESSMENT FORM 2

Date: Version: Authorised by: Next Review:

Template date: 3 July 2012 Version:1.2 Authorised by: Director, OHS and Injury Management Next Review: 3 July 2015 © The University of Melbourne – Uncontrolled when printed.
STEP 3 – IDENTIFY HAZARDS AND ASSOCIATED RISK SCORES AND CONTROLS
For each of the following prompts: Hierarchy of Control (Control Type)
• Check the box for each hazard that may potentially exist for the plant; El – Elimination
• Either: S – Substitution
o if using the two variable risk matrix, determine and record the likelihood, consequences and the risk rating, or En – Engineering Is – Isolation G – Guarding
o if using the three variable risk calculator, determine and record the exposure, likelihood, consequences and the risk score. A – Administrative T –Training In – Inspection
• In the comments box, describe when and where the hazard is present; M – Monitoring P – PPE
• Specify the risk control type from the hierarchy of control at right, for each current or proposed risk control;
• Provide a control description for each current or proposed risk control.
Can the following items become ENTANGLED with moving parts of the plant, or Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
materials in motion:
Hair Jewellery Rags
Gloves Clothing
Other materials – specify:

EMERGENCY STOP BUTTONS - can injury from interaction with the plant be Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
caused by:
Lack of prominence of emergency stop Emergency stop not being fail safe
Emergency stop not red in colour
Stored energy being released slowly or at a sequent time
Lack of clarity of emergency stop markings
Restarting plant by resetting the emergency stop button
Other factors – specify:
Can anyone be CRUSHED due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Falling, uncontrolled or unexpected movement of plant
Lack of capacity to slow, stop or immobilise the plant
Falling, uncontrolled or unexpected movement of plant’s load
Under or trapped between plant and materials or fixed structure
Contact with moving parts during testing, inspection, maintenance, cleaning or repair
Tipping or rolling over Parts of plant collapsing Being thrown off
Other factors – specify:
Can anyone be CUT, STABBED or PUNCTURED by coming in contact with: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Moving plant or parts Work pieces disintegrated
Sharp or flying objects Work pieces ejected
Other factors – specify:

[Link] PLANT - GENERAL RISK ASSESSMENT FORM 3

Date: Version: Authorised by: Next Review:

Template date: 3 July 2012 Version:1.2 Authorised by: Director, OHS and Injury Management Next Review: 3 July 2015 © The University of Melbourne – Uncontrolled when printed.
SHEARING – Can anyone’s body parts be cut off between: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Two parts of the plant
A part of the plan and a work piece or structure
Other factors – specify:

Can anyone be injured by ELECTRICAL shock or burnt due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Damaged/poorly maintained leads or switch
Working near or contact with live electrical conductors
Water near electrical equipment Lack of isolation procedures
Other factors – specify:

Can anyone be injured by an EXPLOSION of the following items triggered by plant Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
operation
Gas Dust
Vapours Liquids
Other factors – specify:

FRICTION - Can anyone be burnt due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Contact with moving parts or surfaces of the plant
Material handled by the plant
Other factors – specify:

Can anyone be STRUCK by moving objects due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Plant or work pieces being ejected or disintegrated Mobility
Uncontrolled or unexpected plant movement
Other factors – specify:

[Link] PLANT - GENERAL RISK ASSESSMENT FORM 4

Date: Version: Authorised by: Next Review:

Template date: 3 July 2012 Version:1.2 Authorised by: Director, OHS and Injury Management Next Review: 3 July 2015 © The University of Melbourne – Uncontrolled when printed.
Can anyone using the plant or in the vicinity of the plant, SLIP, TRIP or FALL due Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
to:
The working environment Uneven work surfaces Lack of guardrails
Poor housekeeping Slippery work surfaces
Other factors – specify:

Can anyone be SUFFOCATED due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Lack of oxygen
Atmospheric contamination
Other factors – specify:

HIGH TEMPERATURE OR FIRE – Can anyone: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Come into contact with objects at high temperature
Be injured by fire
Other factors – specify:

TEMPERATURE (Thermal Comfort) – Can anyone suffer ill health due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Exposure to high temperatures
Exposure to low temperatures
Other factors – specify:

Can anyone come into contact with FLUIDS or GASES under HIGH PRESSURE due Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
to:
Failure of the plant?
Misuse of the plant?
Other factors – specify:

[Link] PLANT - GENERAL RISK ASSESSMENT FORM 5

Date: Version: Authorised by: Next Review:

Template date: 3 July 2012 Version:1.2 Authorised by: Director, OHS and Injury Management Next Review: 3 July 2015 © The University of Melbourne – Uncontrolled when printed.
ERGONOMIC (incl manual handling) - Can anyone be injured due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Seating design Excessive effort
Repetitive body movement or posture Poor lighting
Poor workplace or plant design Controls layout and design
Lack of consideration for human behaviour causing mental or physical stress
Other factors – specify:

RADIATION Can anyone be injured/suffer ill health due to: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Ionising radiation Lasers Ultraviolet light
Microwaves Radio waves Magnetic resonance
Other – specify:

Can anyone be injured or suffer ill health from exposure to OTHER HAZARDS: Risk score Comments (when and where hazard is present) Control type Control description (current & proposed)
Chemicals Fumes Dusts
Vibration Noise Biologicals
Toxic gases or vapours
Other factors – specify:

STEP 4 – COMPLETE THE IMPLEMENTATION OR ESCALATION PLAN

Determine the person responsible for deciding upon and implementing the proposed controls. Obtain the authorisation of the management representative.
Ensure the HSR (if applicable) has been consulted. Ensure the user(s) of the plant have been consulted.
Person responsible or escalated to Controls due date
Signature of management representative Date
Signature of HSR/employee representative Date
Signature of plant user Date

For use in conjunction with the OHS Risk management procedure and the Regulated plant risk management procedure.
For further information, refer to [Link] or contact your local OHS practice expert.

[Link] PLANT - GENERAL RISK ASSESSMENT FORM 6

Date: Version: Authorised by: Next Review:

Template date: 3 July 2012 Version:1.2 Authorised by: Director, OHS and Injury Management Next Review: 3 July 2015 © The University of Melbourne – Uncontrolled when printed.
Extra writing room - use this page to enter extended comments or descriptions
Risk Score

[Link] PLANT - GENERAL RISK ASSESSMENT FORM 7

Date: Version: Authorised by: Next Review:

Template date: 3 July 2012 Version:1.2 Authorised by: Director, OHS and Injury Management Next Review: 3 July 2015 © The University of Melbourne – Uncontrolled when printed.