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Example Risk Assessment Form

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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Azhar Aris
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© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
301 views

Example Risk Assessment Form

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.

Uploaded by

Azhar Aris
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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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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