Plant Risk Assessment

1. Plant Details

Company Name: [Enter Company Name] Site/Location: [Enter Site Location] Date of Assessment: [DD/MM/YYYY] Assessor Name(s): [Enter Names] Job Title: [Enter Title]

Item	Description
Plant Item/ID:	[Enter ID or Name]
Make/Model:	[Enter Make and Model]
Serial Number:	[Enter Serial Number]
Plant Type:	[e.g., Mobile Plant, Elevating Work Platform, Power Tool]
Specific Task:	[Describe the specific work the plant is used for]

2. Hazard Identification

List all hazards associated with the plant and the task. Consider the environment, operation, maintenance and disposal.

Hazard	Description of Hazard
1. [Hazard e.g. Moving Parts]	[Describe specific risk like unguarded rotating shaft]
2. [Hazard e.g. Electrical]	[Describe risk like exposed wiring]
3. [Hazard e.g. Noise]	[Describe risk like level exceeding 85dB]
4. [Hazard e.g. Manual Handling]	[Describe risk like heavy lifting required]
5. [Hazard]	[Description]

3. Risk Assessment

Assess the risk before controls are applied using the Risk Matrix below.

Hazard	Likelihood (A-E)	Consequence (1-5)	Risk Rating (H/M/L)
[Hazard 1]	[A-E]	[1-5]	[Rating]
[Hazard 2]	[A-E]	[1-5]	[Rating]
[Hazard 3]	[A-E]	[1-5]	[Rating]

Risk Matrix Legend:

• Likelihood: A = Very Rare, B = Unlikely, C = Possible, D = Likely, E = Certain
• Consequence: 1 = Insignificant, 2 = Minor, 3 = Moderate, 4 = Major, 5 = Catastrophic

4. Risk Controls

Select controls using the Hierarchy of Control (Elimination, Substitution, Engineering, Administration, PPE).

Hazard	Existing Controls	New/Additional Controls	Hierarchy Level	Residual Risk Rating (H/M/L)
[Hazard 1]	[List current controls]	[Proposed new controls]	[e.g. Engineering]	[Rating]
[Hazard 2]	[List current controls]	[Proposed new controls]	[e.g. PPE]	[Rating]
[Hazard 3]	[List current controls]	[Proposed new controls]	[e.g. Admin]	[Rating]

5. Action Plan & Review

Control Action	Who is Responsible	Target Date	Completed?	Date Reviewed
[Action 1]	[Name]	[Date]	[Yes/No]	[Date]
[Action 2]	[Name]	[Date]	[Yes/No]	[Date]

6. Consultation

List the workers or representatives consulted during this assessment. Names: [Enter Names]

7. Sign Off

I confirm that to the best of my knowledge the information in this assessment is accurate and controls will be implemented.

Signature: __________________________ Name: __________________________ Date: __________________________

Review Date: __________________________