SITXWHS006
Appendix A – WHS Hazard Identification and Risk Assessment Form
Risk Assessment completed by:
Date:
Assessment task:
Implementation
Activity/ Person
Hazards
Affected Potential risks
(describe the hazard and location) Risk Risk control measure
(work activity or job (describe consequences and
Score (based on Hierarchy of Controls) Action by Due Date
role associated with impacts of the risk)
hazard)
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SITXWHS006
Implementation
Activity/ Person
Hazards
Affected Potential risks
(describe the hazard and location) Risk Risk control measure
(work activity or job (describe consequences and
Score (based on Hierarchy of Controls) Action by Due Date
role associated with impacts of the risk)
hazard)
Risk Analysis Matrix – Level of Risk
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SITXWHS006
Risk Assessment Risk Score Action required -
Identified Hazards Risk Level
Likelihood Consequence Hierarchy of Controls
(L x C)
(L) (C)
Likelihood
Severity The numbers 1 to 6 in the chart indicate the level
Very likely Likely Unlikely Very unlikely of risk.
Fatal 1 1 2 3 1 to 2 = High (take action immediately)
3 to 4 = Medium (take action as soon as
Critical 1 1 2 3 possible)
5 to 6 = Low (may not need to take action)
Major 1 2 3 4
Minor 2 3 4 5
Negligible 3 4 5 6
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SITXWHS006
Hierarchy of Risk Controls
Elimination is a permanent solution and should be attempted in the first instance.
Substitution involves replacing the hazard or environmental aspect by one of lower risk.
Engineering controls involve physical barriers or structural changes to the environment or process.
Administrative controls reduce hazard by altering procedures and providing instructions.
Personal protective equipment last resort or temporary control.
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