Job Safety Analysis

Site location Date

Description of activity

Activity Hazards Risk control measures

List the tasks required to perform the Inherent Residual
Against each task, list the hazards that could List the control measures required to minimise the
activity in the sequence they are
cause injury when the task is performed.
risk score risk of injury arising from the identified hazard.
risk score
carried out.

Page 1 of 6 CPCCCA3001 Job safety analysis Template

© Durban International College Pty Ltd ABN 73127947326

DIC ID: 40268 CRICOS ID: 02915G

 Activity Hazards Risk control measures
List the tasks required to perform the Inherent Residual
Against each task, list the hazards that could List the control measures required to minimise the
activity in the sequence they are
cause injury when the task is performed.
risk score risk of injury arising from the identified hazard.
risk score
carried out.

Page 2 of 6 CPCCCA3001 Job safety analysis Template

© Durban International College Pty Ltd ABN 73127947326

DIC ID: 40268 CRICOS ID: 02915G

 Activity Hazards Risk control measures
List the tasks required to perform the Inherent Residual
Against each task, list the hazards that could List the control measures required to minimise the
activity in the sequence they are
cause injury when the task is performed.
risk score risk of injury arising from the identified hazard.
risk score
carried out.

Page 3 of 6 CPCCCA3001 Job safety analysis Template

© Durban International College Pty Ltd ABN 73127947326

DIC ID: 40268 CRICOS ID: 02915G

 Implementation and consultation process
Record below the names of the persons consulted.

Determine the person responsible for reviewing and implementing the risk assessment including the identified controls. Obtain the authorisation of
the management representative (i.e. the Assessor).
Person responsible for
Signature
implementation

Management representative Signature

Learner name Learner signature

Assessor name Assessor signature

Page 4 of 6 CPCCCA3001 Job safety analysis Template

© Durban International College Pty Ltd ABN 73127947326

DIC ID: 40268 CRICOS ID: 02915G

Risk rating

Consequence

Insignificant Minor Moderate Major Catastrophic

Almost certain High High Extreme Extreme Extreme

Likelihood Likely Medium High High Extreme Extreme

Possible Low Medium High High Extreme

Unlikely Low Low Medium High Extreme

Rare Low Low Medium High High

Likelihood Consequence

Almost certain Most likely outcome, could occur any time (daily).
Likely Likely to occur, even 50/50 chance (weekly).
Possible Might occur at some time (monthly).
Unlikely to occur, but history of the event exists
Unlikely
within the industry (yearly).
Practically impossible, no known history of event
Rare
occurring, in exceptional circumstances.
Superficial injury or illness such as minor cuts and bruises, first aid treatment, negligible
Insignificant
financial loss, minor property damage, contaminant release immediately contained.
Lost time injury with less than 10 days off work, contaminant release contained without
Minor
outside assistance, notable financial loss, a slight business disruption (property damage).
Serious injury with a long period (10 days or more) off work and/or permanent impairment,
Moderate
substantial financial loss, notable business disruption (more than 1 day).
Major Fatality, significant financial loss, major business disruption, major environmental damage.
Multiple fatalities, extensive financial loss, severe business disruption, severe environmental
Catastrophic
damage.

Risk rating priority for action

Action to reduce risk is mandatory. If work is in progress and an activity is identified as extreme risk – cease work immediately. Work will not commence until action has
Extreme
been taken to lower the risk to another category.
Action to reduce risk is mandatory. If work is in progress and an activity is identified as high risk – consider ceasing work. Immediate action must be taken or controls
High
implemented to reduce the risk. Approval must be obtained from Management to continue work.
Action to reduce risk should be taken. Action must be based on the Hierarchy of Controls. Short-term action can be administrative controls or protective equipment.
Medium
Employees must be made aware of the risk and controls to be taken. Plans for further mitigation must be implemented.

Low Action to reduce risk should be taken. Action must be based on the Hierarchy of Controls. Administrative procedures or protective equipment may control the risk.

Page 5 of 6 CPCCCA3001 Job safety analysis Template

© Durban International College Pty Ltd ABN 73127947326

DIC ID: 40268 CRICOS ID: 02915G

Page 6 of 6 CPCCCA3001 Job safety analysis Template
© Durban International College Pty Ltd ABN 73127947326

DIC ID: 40268 CRICOS ID: 02915G