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This template is to be used with reference to the OHS Risk Management Procedure and OHS Risk Management Guide. For support in conducting a
Risk Assessment contact the OHS Advisory Service on 1300 074 715 or email safety@edumail.vic.gov.au.
1. Background Information
School/Workplace: Date:
Title of Assessment: Name of person
conducting
assessment:
2. Risk Assessment
Identify and list Hazards List Current Risk Controls Risk Rating List Additional Controls (if any)
Central Office Use Only Issue Date: July 2017 Last Reviewed: N/A Next Review: July 2019
No. DET ESWB 04-3-1 Authorised by: Manager ESWU
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED Page 1 of 3
Risk Assessment Template
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Central Office Use Only Issue Date: July 2017 Last Reviewed: N/A Next Review: July 2019
No. DET ESWB 04-3-1 Authorised by: Manager ESWU
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED Page 2 of 3
Risk Assessment Template
1. Evaluate the
consequences of a risk Rare 1 May occur somewhere, sometime (“Once in a life time /
Insignificant 1 No injury
occurring according to the once in a hundred years”)
ratings in the top row
Unlikely 2 May occur somewhere within DET over an extended
Minor 2 Injury/ ill health requiring first period of time
2. Evaluate the likelihood aid
Possible 3 May occur several times across DET or a region over a
of an incident occurring Moderate 3 Injury/ill health requiring period of time
according to the ratings in medical attention
Likely 4 May be anticipated multiple times over a period of time
the left hand column
Major 4 Injury/ill health requiring May occur once every few repetitions of the activity or
hospital admission event
3. Calculate the level of
risk by finding the Severe 5 Fatality Almost 5 Prone to occur regularly
intersection between the Certain
It is anticipated for each repetition of the activity of event
likelihood and the
consequences
Central Office Use Only Issue Date: July 2017 Last Reviewed: N/A Next Review: July 2019
No. DET ESWB 04-3-1 Authorised by: Manager ESWU
THIS DOCUMENT IS UNCONTROLLED WHEN PRINTED Page 3 of 3