RISK ASSESSMENT FORM

School / Department & Exact Location Of The Work Performed: Project / Work Description:

Risk Assessment Team (Name/s): Approved By Supervisor / Reporting Officer:

(Name, Date & Signature)

Date Conducted: Next Review Date:

Hazard Identification Risk Evaluation Risk Control

1a. 1b 1c. 1d. 2a. 2b. 2c. 2d. 3a 3b 3c 3d 3e

S/N Work activity Hazard Possible Accident/ Ill Existing Risk Severity Likelihood RPN* Additional Risk Control Severity Likelihood RPN* Follow up by (name) &
health to persons, fire or Control Measures date
property loss 1. Elimination
2. Substitution
3. Engineering Control
4 .Administrative Control
5 .PPE

*RPN - Risk Prioritization Number

 3f

Remarks
 RISK ASSESSMENT FORM
School / Department & Exact Location Of The Work Performed: Project / Work Description:

Risk Assessment Team (Name/s): Approved By Supervisor / Reporting Officer:

(Name, Date & Signature)

Date Conducted: Next Review Date:

Hazard Identification Risk Evaluation Risk Control

1a. 1b 1c. 1d. 2a. 2b. 2c. 2d. 3a 3b 3c 3d 3e

S/N Work activity Hazard Possible Accident/ Ill Existing Risk Severity Likelihood RPN* Additional Risk Control Severity Likelihood RPN* Follow up by (name) &
health to persons, fire or Control Measures date
property loss 1. Elimination
2. Substitution
3. Engineering Control
4 .Administrative
Control
5 .PPE

*RPN - Risk Prioritization Number

 3f

Remarks
Instructions for using the Risk Assessment form
Header Fill up all sections in the header of the RA form. No
with your supervisor/reporting officer on the next review date for the RA. Normally the next review d
one year ahead. The RA is also reviewed
(1) When there are changes in work
processes/activities (2) After any accidents/incidents
Note 2: Check your Division rules about team or individ
submission for RA

Column 1b Describe the work activity to be carried out. Note

not fill in names of machines/equipment to be used. Therefore, a compute
activity, but working on a computer is

Column 1c Identify hazard(s) associated with the activity to be carried out.

hazards include chemical, biological, electrical, mechanical, physical, ergonomics, psychosocial, slip & fall etc.

Column 1d Identify possible accidents/ill health associated with each identified hazard. Ex
possible accidents/ill health include fires, explosions, cuts, burns, frost bites, fractures etc.

Column 2a Indicate risk control measures that are already in place to eliminate or minimise risks. Me
control risks may be analysed according to the Hierarchy of Controls: Elimination, Substitution, Engineering Con
Administrative Controls and Personal Protective Equipment (PPE). Elimination of the hazard sho
priority while PPE should be the last line of defence.
Elimination
Example: Use water based solvents instead of organic based solvents
Substitution
Example: Use a less toxic solvent
Engineering Controls
Example: Use of fume cupboard or gloves boxes Ad
Controls Example:
instructions. Good laboratory practices. Training on proper use of chemicals PPE
Example: Use o
eyewear plus respiratory protection, use of gloves
Column 2b S=Severity Severity i
or extent of injury or harm caused by the hazards, or as a result of an accident. Choose the most likely
from a value between 1 and 5, rather than the most extreme. Refer to the Risk Matrix tab fo
severity table

Column 2c L=Likelihood Likelihood o

of an accident, incident or ill health is defined as the probability that the said accident, incident or ill h
happen. Choose the likelihood from a value between 1 and 5. Consider the records of such events hap
the past when deciding on the likelihood. Refer to the Risk Matrix tab for the likeli

Column 2d RPN=Risk Prioritisation Number RPN=Sev

Likelihood All RPNs should no
than 6

Column 3a Additional risk control measures are required when the RPN indicated in column 2d exceeds 6. If the R
less, enter "NA" in the column

Column 3b S=Severity Sm
upon introduction of additional control measures

Column 3c L=Likelihood
L may reduce upon introduction of additional control measures

Column 3d RPN=Risk Prioritisation Number

RPN will reduce upon introduction of additional control measures

Column 3e Enter the name of the person appointed to oversee the implementation of the additional control measures. En
follow-up date.

Column 3f Enter any remarks

 Note 1: Discuss
. Normally the next review date is up to
The RA is also reviewed:
here are changes in work
any accidents/incidents
n rules about team or individual

Note: Please do
Therefore, a computer is not an

Examples of
cs, psychosocial, slip & fall etc.

Examples of
actures etc.

e risks. Methods to
n, Substitution, Engineering Controls,
Elimination of the hazard should take first

vents

Administrative
Example: Work
PPE
Example: Use of safety
 Severity is the degree
ident. Choose the most likely severity
efer to the Risk Matrix tab for the

Likelihood of occurance
said accident, incident or ill health will
he records of such events happening in
Risk Matrix tab for the likelihood table

RPN=Severity X
All RPNs should not be more

column 2d exceeds 6. If the RPN is 6 or

S may reduce

additional control measures. Enter the

Risk Assessment Matrix
Risk Prioritisation Number = Severity x Likelihood

Severity Table

Pt Severity level Workplace Safety Workplace Health Environment Fire Damage Downtime Incurred

Acute Poisoning,
Fatality, More Than $10 More than 1 year for
single or multiple Failure of Major Spills to Outside Campus million damages full re-instatement
Bodily Functions
5 Critical
Permanent Body Infection with No Infection - outside
Injury or Loss of Use
for more than 30 days Known Cure Campus area

Injury requiring 30 days Moderate exposure,

Reversible injury to Spills to Outside Building More Than $1 More than 3 months for
of hospitalisation
and/or medical leave Bodily Functions on million damages full re-instatement
prolong recovery
4 Very Serious
Temporary Body Injury Infection with Infection - outside
or Loss of Use for more Known Cure but Building area but within
than 10 days but not extensive treatment Campus
exceeding 30 days

Mild exposure,
Injury requiring 10 days Reversible injury to Spills to Outside More Than $100k More than 1 month for
of hospitalisation Bodily Functions Laboratory/Room damages full re-instatement
and/or medical leave with less than 30
days recovery
3 Serious

Temporary Body Infection with Infection - outside

Injury or Loss of Use Known Cure but Laboratory area but
for up to 10 days extensive treatment within building

Very Mild exposure,

Injury requiring Reversible injury to Spills to Outside More Than $10k More than 5 days for
maximum of 3 days of Bodily Functions Workplace but within damages full re-instatement
medical leave only with less than 3 days laboratory
recovery
2 Marginal

Temporary Body Infection with Infection - outside

Injury or Loss of Use Known Cure but workplace but within
for 3 days or less treatment needed Laboratory

Very Mild exposure,

Reversible injury to Spills within Workplace Less than $5k No significant
First aid treatment only Bodily Functions only damages downtime
with less than 3 days
recovery
1 Negligible

No Infection or infection
No or superficial injury No Exposure with no effects within
workplace

Likelihood Table
Pt Likelihood level Likelihood of Occurrence / Exposure Criteria

5 Frequent Likely to occur many times per year

4 Moderate Likely to occur once per year
3 Occasional Might occur once in three years
2 Remote Might occur once in five years
 1 Unlikely Might occur once in ten years

Risk level Determination - 5 x 5 Matrix

SEVERITY
Critical Very Serious Serious Marginal Negligible
(5) (4) (3) (2) (1)

Frequent 25 20 15 10 5
(5) Operation not Operation not High priority Review at Risk acceptable
permissible permissible appropriate time

Moderate 20 16 12 8 4
(4) Operation not Operation not High priority Review at Risk acceptable
permissible permissible appropriate time
LIKELIHOOD

Occasional 15 12 9 6 3
Review at appropriate
(3) High priority High priority time Risk acceptable Risk acceptable

Remote 10 8 6 4 2
Review at Review at
(2) appropriate time appropriate time Risk acceptable Risk acceptable Risk acceptable

Unlikely 5 4 3 2 1
(1) Risk acceptable Risk acceptable Risk acceptable Risk acceptable Risk acceptable

Review the risk assessment records every year or whenever there are changes in processes, work activities or upon
any incident occurrence, whichever is earlier.

Action Table
Colour Score Risks Action

Operation not Permissible

16 - 25 High
Stop operation & review controls. If necessary abort
experimentation.

High priority remedial action

12 - 15 Warning Proceed with extreme caution with PI present at all times.
Implement additional (secondary) controls immediately. Review
within 7 days. Emergency control measures shall be in place.

Take remedial action at appropriate time

8 -10 Medium
Proceed with care. Additional control is advised. Review shall be
implemented within 30 days.
 Risk acceptable: Residual risk

If possible, risk reduction should be further considered,

1-6 Warning particularly severity.

There are no imminent dangers. Frequent review shall be in place

especially changes in procedures, materials or environment.
 RISK ASSESSMENT FORM
School / Department & Exact Location Of The Work Performed: Project / Work Description: Working with Lathe Machine
(Example: SPMS -PAP - Lab A)

Risk Assessment Team (Name/s): Hazman(Team Leader), Sayuti, Hazim, Aflah, Hakimi. Approved By Supervisor / Reporting Officer:
(Name, Date & Signature)
Dr wan Emry Bin Wan Abdul Rahman (Project Supervisor), 6th November 2017.
Date Conducted: 6th November 2017. Next Review Date: 13th November 2017

Hazard Identification Risk Evaluation Risk Control

1a. 1b 1c. 1d. 2a. 2b. 2c. 2d. 3a 3b 3c 3d

S/N Work activity Hazard Possible Accident/ Ill Existing Risk Severity Likelihood RPN* Additional Risk Control Severity Likelihood RPN*
health to persons, fire or Control Measures
property loss 1. Elimination
2. Substitution
3. Engineering Control
4 .Administrative Control
5 .PPE

1 Operate machine without appropriate Physical Hazard Injury Wear appropriate 3 2 6 NA NA NA NA

attire PPE such as
goggles, over-
garment (safety
jacket), safety
shoes and etc.

2 inproper management of wire when Electrical Hazard Electrocution due to high Warning signs are 4 3 12 Regular servicing and 4 1 4
machine is turned on voltage displayed beside maintenance of lathe
system to warn machine to avoid
users of high malfuction and failure
voltage -manage happen
proper wire
system of the
machine and
avoid the exposed
to life wire

3 oil or lubricant was not channel Biological Hazard stagnant oil split & The waste oil and 3 2 6 NA NA NA NA
properly contaminate coolen must
environment dispose to the
proper place

4 Operate machine on own way Physical Hazard Injury, fatal and machine Operate machine 4 1 4 NA NA NA NA
breakdown using the right
SOP
 5 Closing movement between the slide- Physical Hazard Hand crushing Avoid any bare 3 2 6 NA NA NA NA
waste and fixed parts (tail stock) hand contact
while operating
the machine

6 Contact with cutting fluids, oil and Chemical hazard Irritate skin Avoid touching 3 4 12 Wear Personal Protective 1 5 5
grease any cutting fluids, Equipment like safety glove
oil and grease and gogle to avoid the
with bare skin waste product splattered
into the eye

7 Machine out of control Physical Hazard Injury or fatal Set up an 5 1 5 NA NA NA NA

emergency button

8 Switching off machine with wet hand Electrical Hazard Electric shock Make sure hands 5 1 5 NA NA NA NA
are completely
dry before
touching the
switch

9 Playing around the machine Psycho-social Hazard Injury or fatal Follow the rules 3 3 9 Creating a gap or provide a 3 2 6
distance between the users
with the lathe machine.

10 Operate the machine in pressure Psycho-social Hazard Injury or fatal Do not operate 2 2 4 NA NA NA NA
condition machine in high
pressure
condition

11
*RPN - Risk Prioritization Number
mber 2017.

ntrol
3e 3f

Follow up by (name) & Remarks

date

NA NA

(Johnny) 13th March NA

2012

NA NA

NA NA
NA NA

NA NA

NA NA

NA NA

NA NA

NA NA
 RISK ASSESSMENT FORM
School / Department & Exact Location Of The Work Performed:
(Example: SPMS -CBC - Lab K)

Risk Assessment Team (Name/s): Benny

Date Conducted: 11th March 2012 Next Review Date: 10th March 2013

Hazard Identification Risk Evaluation

1a. 1b 1c. 1d. 2a. 2b.

S/N Work activity Hazard Possible Accident/ Ill Existing Risk Severity
health to persons, fire or Control
property loss

1 Weighing chemicals for the synthesis Irritant Chemicals Irritation when come in Handle under 1
work contact with skin and fumehood.
eyes Put on required
PPE - safety
glasses, lab coat,
long pants, gloves,
covered shoes.

2 Prepare glassware and add Glass breakage due Cuts on skin/eye due to Inspect glassware 3
to overpressure
chemical into chemical reactor (chemical flying particles before use.
reaction) Put on required
PPE - safety
glasses, lab coat,
long pants, gloves,
covered shoes.
*RPN - Risk Prioritization Number
ISK ASSESSMENT FORM
Project / Work Description: Chemical works

Approved By Supervisor / Reporting Officer:

(Name, Date & Signature)
Prof Xiao (Project Supervisor), 16th March 2012

Risk Evaluation Risk Control

2c. 2d. 3a 3b 3c 3d 3e 3f

Likelihood RPN* Additional Risk Control Severity Likelihood RPN* Follow up by (name) & Remarks
Measures date
1. Elimination
2. Substitution
3. Engineering Control
4 .Administrative
Control
5 .PPE

3 3 NA NA NA NA NA NA

3 9 Install pressure control / 3 1 3 (Benny) Ongoing NA

relief valves
Supervisor to brief group
to pull down fumehood
sash
 RISK ASSESSMENT FORM
School / Department & Exact Location Of The Work Performed:
(Example: Office)

Risk Assessment Team (Name/s): Joey

Date Conducted: 11th March 2012 Next Review Date: 10th March 2013

Hazard Identification Risk Evaluation

1a. 1b 1c. 1d. 2a. 2b.

S/N Work activity Hazard Possible Accident/ Ill Existing Risk Severity
health to persons, fire or Control
property loss

1 Sorting of documents / Use of paper Contact with sharp Cuts and lacerations to Handle files and 1
edges (from paper hand and fingers documents with
edges and bent care, avoiding
plaster dividers fingers running
along the edge of
papers.
Discard bend
plastic folders.

Punching holes for document Strike by moving Fingers may get injured Proper usage of 1
to be filed parts or caught (crush) during punching hole punch
between moving Do not overload
parts paper for
punching
Maintenance of
hole puncher
 Ergonomic hazard Muscular starins Staff to adopt 3
(repetive similar good ergonomice
action) practice e.g. table
height. Job
rotations; avoid
prolong repetitive
punching
operation.
Brief staff on
proper usage of
hole punch.

*RPN - Risk Prioritization Number

RISK ASSESSMENT FORM
Project / Work Description: General Office Activities

Approved By Supervisor / Reporting Officer:

(Name, Date & Signature)
Mr Lim (Manager), 16th March 2012

Risk Evaluation Risk Control

2c. 2d. 3a 3b 3c 3d 3e

Likelihood RPN* Additional Risk Control Severity Likelihood RPN* Follow up by (name) &
Measures date
1. Elimination
2. Substitution
3. Engineering Control
4 .Administrative Control
5 .PPE

4 4 Provide finger cots to staff 1 3 3 Office Staff (April 2012)

to lift paper

3 3 NA NA NA NA NA
1 3 NA NA NA NA NA
 3f

Remarks

NA

NA
NA