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  • Example Risk Assessment Form

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    Azhar Aris
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    This risk assessment form evaluates three areas - the tandas, dapur, and taking items - and identifies hazards, possible effects, current risk controls, likelihood and severity of risk, legal requirements, and recommendations for improving safety. The tandas presents a slip hazard from a wet floor that could be addressed by providing rubber mats and safety training. The dapur poses a fire risk that could be mitigated by installing sprinklers, improving ventilation, and establishing safety procedures. Taking items from high places risks falls that training and use of ladders could help prevent.

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    EXAMPLE RISK ASSESSMENT FORM.doc

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    This risk assessment form evaluates three areas - the tandas, dapur, and taking items - and identifies hazards, possible effects, current risk controls, likelihood and severity of risk, legal requirements, and recommendations for improving safety. The tandas presents a slip hazard from a wet floor that could be addressed by providing rubber mats and safety training. The dapur poses a fire risk that could be mitigated by installing sprinklers, improving ventilation, and establishing safety procedures. Taking items from high places risks falls that training and use of ladders could help prevent.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    156 views2 pages

    Example Risk Assessment Form

    Uploaded by

    Azhar Aris
    This risk assessment form evaluates three areas - the tandas, dapur, and taking items - and identifies hazards, possible effects, current risk controls, likelihood and severity of risk, legal requirements, and recommendations for improving safety. The tandas presents a slip hazard from a wet floor that could be addressed by providing rubber mats and safety training. The dapur poses a fire risk that could be mitigated by installing sprinklers, improving ventilation, and establishing safety procedures. Taking items from high places risks falls that training and use of ladders could help prevent.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    of 2

    EXAMPLE RISK ASSESSMENT FORM

    Activities/
    Process/
    Facilities/
    Location

    Effect

    Tandas

    Hazard
    (from plant,
    equipment,
    materials,
    environment
    )
    Lantai Licin

    Current Risk
    Control

    Terjatuh

    Cuci 1 kali
    sehari

    Dapur

    Api

    Kebakaran

    1. Ventilation
    system

    Likelihood

    Risk Rating
    Severity

    Legal
    Requireme
    nt

    Action & Recommendations

    12

    OSHA 1994
    Seksyen 15
    (2) (e)

    12

    OSHA 1994
    Seksyen 15
    (2) (b) (e),
    Seksyen 24
    (1) (a) (b).

    1. Eliminate:
    - Tiada
    2. Subtitute:
    - Tiada
    3. Isolate
    - Tiada
    4. Engineering Control:
    - Gunakan rubbermate.
    5. Admin Control:
    - Training (Awareness)
    6. PPE:
    - Rubber shoes.
    1. Eliminate:
    - Tiada
    2. Subtitute:
    - Tiada
    3. Isolate:
    - Asingkan bahagian dapur
    4. Engineering control
    - Sprinkler
    5. Admin control
    - Training (Awareness), Safety
    procedures
    6. PPE

    Risk
    Factor

    Ambil
    barang

    Memanjat
    kerusi

    Likelihood:
    1
    Highly Unlikely
    2
    Unlikely
    3
    Likely
    4
    Very likely

    Terjatuh
    dan cedera
    (spt patah
    kaki,
    terseliuh)

    Training,
    S.O.P,

    Severity
    1
    Neglible injuries
    2
    Minor Injuries
    3
    Major injuries
    4
    Fatality

    6
    (MEDIUM)

    1. Eliminate (Penghapusan)
    Tiada
    2. Subtitute (Penggantian)
    Tiada
    3. Isolate
    Tiada
    4. Engineering Control (Kawalan
    Kejuruteraan)
    Guna tangga
    5. Admin Control (Kawalan
    Pentadbiran)
    Latihan penggunaan tangga,
    Prosedur Kerja Selamat.
    6. PPE (Peralatan Perlindungan Diri)
    Kasut sarung.

    Other Likelihood Factors to Consider:


    Category of Hazards:
    a) number of personnel exposed
    1. Mechanical
    b) frequency and duration of exposure to the hazard
    2. Electrical
    c) quantity or concentration of materials
    3. Biological
    d) failure of service
    4. Chemical
    e) failure of plant and machinery components
    5. Ergonomics
    f) exposure to the elements
    6. Psycho-social

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