AssessmentTask 1.3 - WHS Hazard Checklist
AssessmentTask 1.3 - WHS Hazard Checklist
AssessmentTask 1.3 - WHS Hazard Checklist
Topic:
Assessment
Task:
Assessment Due
Date:
Week 4
Duratio
n:
3 hours
Assessment Criteria:
BSBWHS401:
applying organisational WHS management systems and procedures in the work team area
applying procedures for assessing and controlling risks to health and safety associated with
those hazards, according to the hierarchy of control and as specified in commonwealth and
state or territory WHS Acts, regulations and codes of practice
providing specific, clear and accurate information and advice on workplace hazards to work
team
knowledge of legal responsibilities of managers, supervisors, PCBUs or their officers and
workers in the workplace.
Assessment Instructions to Student:
Write your name as it appears on your enrolment form in the appropriate area on this
form
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Hazard Checklist
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Participant
Name:
Date:
Element:
1.
Yes
No
N/A
Action required
LAYOUT
ENVIRONMENT
Temperature is comfortable
Lighting is adequate
Area is free from odours
Noise level is acceptable
Ventilation
is adequate
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Incident/Injury Report
Outcome of incident:
Near Miss
Injury
Property Damage
Gender:
Female
Date of Birth:
Address:
Email:
Mob Phone:
Home Phone:
Position:
Employee
Employment Status:
Full Time
Job Role:
Contractor
Visitor
Part Time
Volunteer
Casual
2. Details of incident
Date:
Time:
Location:
Describe what happened and how it
occurred:
3. Details of injury
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4. Treatment administered
Yes
No
No
Hospitalised
Workers
compensation
claim
Returned to
normal work
Alternative
duties
Rehabilitation
6. Details of witness
Were
there
any Yes
witnesses?
If Yes, complete the information below:
No
Witness Name:
Mobile Phone
Home Phone:
Email:
Address:
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7. Incident investigation
Comments to include causal factors, add extra sheets if needed:
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Potential risk
Impact
Rare
Unlike
ly
Possibl
e
Likely
Almost
certain
Catastrophic
Major
Moderate
Minor
VL
VL
Insignificant
IMPACT:
Catastrophic
Major
Moderate
Minor
Insignificant
LIKELIHOOD:
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Almost certain
Likely
Possible
Unlikely
Rare
Risk level
Required action
Act immediately:
The proposed task or process activity must not proceed. Steps must be taken to
lower the risk level to as low as reasonably practicable using the hierarchy of risk
controls.
Critical (C)
Act today:
The proposed activity can only proceed, provided that:
(i) the risk level has been reduced to as low as reasonably practicable using
the hierarchy of risk controls;
(ii) the risk controls must include those identified in legislation, Standards,
Codes of Practice etc.
(iii) the risk assessment has been reviewed and approved by the Supervisor
and
(iv) The supervisor must review and document the effectiveness of the
implemented risk controls.
High (H)
Low (L)
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Although the risk level is low the situation should be monitored periodically to
determine if the situation changes.
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Who/when
Long-term controls
Who/when
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Review date
Person to Reviewed
(Name)
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