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Identify hazards, assess risks and document controls before work begins.
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Hazard Identification
Review each hazard category. Mark Y if present, N if not applicable. Record specific details and initial risk rating in the Notes column.
| # | Hazard Category | Y | N | Notes / Specific Hazards |
|---|---|---|---|---|
| Hazard Identification | ||||
| 1 | Working at heights: ladders, scaffolds, roofs, platforms, edges | |||
| 2 | Manual handling: lifting, pushing, pulling, repetitive movement | |||
| 3 | Electrical: live circuits, overhead lines, damaged cables, switchboards | |||
| 4 | Chemical: hazardous substances, gases, dust, fumes, spills | |||
| 5 | Confined spaces: tanks, pits, vaults, enclosed areas with limited access | |||
| 6 | Mobile plant: forklifts, excavators, trucks, vehicles in work area | |||
| 7 | Falling objects: unsecured tools, materials, overhead work, stacking | |||
| 8 | Environmental: extreme heat/cold, UV, noise, poor lighting, uneven ground | |||
Risk Rating Matrix
Use the matrix below to rate each identified hazard. Risk = Likelihood × Consequence.
| Likelihood ↓ / Consequence → | Insignificant (1) | Minor (2) | Moderate (3) | Major (4) | Catastrophic (5) |
|---|---|---|---|---|---|
| Almost certain (5) | M | H | H | E | E |
| Likely (4) | M | M | H | H | E |
| Possible (3) | L | M | M | H | H |
| Unlikely (2) | L | L | M | M | H |
| Rare (1) | L | L | L | M | M |
Control Measures
For each identified hazard, document control measures using the hierarchy of controls. Record the initial risk rating and the residual risk after controls.
| # | Hazard | Control Measures | Initial Risk | Residual Risk |
|---|---|---|---|---|
| Control Measures & Residual Risk | ||||
| 1 | Working at heights | |||
| 2 | Manual handling | |||
| 3 | Electrical | |||
| 4 | Chemical / hazardous substances | |||
| 5 | Confined spaces | |||
| 6 | Mobile plant / vehicles | |||
| 7 | Falling objects | |||
| 8 | Environmental conditions | |||
Additional Hazards
Record any site-specific hazards not covered above. Apply the same risk rating and control measure process.
| # | Hazard Description | Control Measures | Initial Risk | Residual Risk |
|---|---|---|---|---|
| Site-Specific Hazards | ||||
| 9 | ||||
| 10 | ||||
| 11 | ||||
| 12 | ||||
| 13 | ||||
| 14 | ||||
Communication
Record all persons briefed on this risk assessment and its control measures.
| # | Name | Role / Company | Signature | Date |
|---|---|---|---|---|
| Persons Briefed | ||||
| 1 | ||||
| 2 | ||||
| 3 | ||||
| 4 | ||||
| 5 | ||||
| 6 | ||||
| 7 | ||||
| 8 | ||||
Declaration
I declare that I have identified all reasonably foreseeable hazards associated with this task/activity, assessed the risks and documented appropriate control measures. All persons involved in or affected by this work have been briefed on the identified hazards and required controls. This assessment will be reviewed if conditions change, an incident occurs or at the nominated review date.