| Business (PCBU) | [Business name] |
|---|---|
| Task, area or activity | [What is being assessed] |
| Assessed by | [Name and position] |
| Workers consulted | [Who was consulted] |
| Date assessed | [Date] |
| Next review | [Review date] |
| Jurisdiction | New South Wales |
Laid out against the risk management process in ss 34–38 of the Work Health and Safety Regulation 2025 (NSW): identify hazards (s 34), eliminate or minimise risks (s 35), use the hierarchy of control measures (s 36), maintain controls (s 37) and review them (s 38). The 5×5 matrix is a way to prioritise, not a legal scoring method. This is a draft prepared from the details entered. It does not by itself show that your obligations are met: check it against your workplace, consult the people who will use it, and update it when things change.
Summary
| Hazards assessed | 1 |
|---|---|
| Critical (15–25) | 0 |
| High (10–14) | 1 |
| Moderate (5–9) | 0 |
| Low (1–4) | 0 |
Risk register (highest risk first)
1. Forklifts operating near pedestrians in the warehouse
| Who could be harmed | Warehouse staff, drivers, visitors |
|---|---|
| Likelihood | 3 Possible |
| Consequence | 4 Major |
| Risk rating | High (3 × 4 = 12) |
| Action | Put controls in place before the work continues. |
| Existing controls | Licensed operators; Speed limit signs |
| Further controls | Fixed barriers separating walkways from forklift aisles; Exclusion zone at the loading dock |
| Responsible | [Who] |
| Due | [By when] |
How controls are chosen
- Eliminate the hazard, so far as is reasonably practicable. This applies whatever the rating.
- If that isn’t reasonably practicable, minimise the risk by substitution, isolation or engineering controls (s 36(3) of the Work Health and Safety Regulation 2025 (NSW)).
- Then administrative controls for any remaining risk.
- Then personal protective equipment for any risk that still remains.
Rating scales
Likelihood
| 1 Rare | could happen only in exceptional circumstances |
|---|---|
| 2 Unlikely | could happen but not expected |
| 3 Possible | might happen at some time |
| 4 Likely | will probably happen |
| 5 Almost certain | expected to happen regularly |
Consequence
| 1 Insignificant | no injury, or first aid not needed |
|---|---|
| 2 Minor | first aid |
| 3 Moderate | medical treatment, time off work |
| 4 Major | serious injury or illness, hospital admission |
| 5 Catastrophic | death or permanent disability |
Review
Review this assessment by [review date], and also when a control isn’t working, before a change likely to create a new or different risk, when a new hazard or risk is found, when consultation shows a review is needed, or when a health and safety representative asks (s 38(2) of the Work Health and Safety Regulation 2025 (NSW)).
Sign-off
| Assessed by | Name ____________ Signature ____________ Date ________ |
|---|---|
| Approved by | Name ____________ Signature ____________ Date ________ |
Draft prepared with a free tool. Tailor it before use. General information, not legal advice.