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

S/N

Work activity

Hazard

Possible Accident/ Ill

health to persons, fire
or property loss

Existing Risk
Control

Severity

Likelihood

RPN*

Additional Risk
Control
Measures

Severity

Likelihood

*RPN - Risk Prioritization Number

r:

Risk Control
3d

3e

3f

RPN*

Follow up by (name) &

date

Remarks

Instructions for using the Risk Assessment form

Header

Fill up all sections in the header of the RA form.

Discuss with your supervisor/reporting officer on the next review date for the R
up to one year ahead.
reviewed:
changes in work processes/activities
accidents/incidents
Division rules about team or individual submission for RA

Column 1b

Describe the work activity to be carried out.

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

Column 1c

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

Examples of hazards include chemical, biological, electrical, mechanical, physical, erg

Column 1d

Identify possible accidents/ill health associated with each identified hazard.

possible accidents/ill health include fires, explosions, cuts, burns, frost bites, fractures

Column 2a

Indicate risk control measures that are already in place to eliminate or minimise risks.
control risks may be analysed according to the Hierarchy of Controls: Elimination, Sub
Administrative Controls and Personal Protective Equipment (PPE).
Eli
priority while PPE should be the last line of defence.
Elimination
Example: Use water based solvents instead of or
Substitution
Example: Use a less toxic solvent
Engineering Controls
Example: Use of fume cupboard or gloves box
Administrative Controls
Example: Work instructions. Good laboratory practice
PPE
Example: Use of safety eyewear plus respiratory pr

Column 2b

S=Severity
the degree or extent of injury or harm caused by the hazards, or as a result of
severity from a value between 1 and 5, rather than the most extreme.
the severity table

Column 2c

L=Likelihood
occurance of an accident, incident or ill health is defined as the probability that
health will happen. Choose the likelihood from a value between 1 and 5. Consid
happening in the past when deciding on the likelihood.
Re
likelihood table

Column 2d

RPN=Risk Prioritisation Number

X Likelihood
be more than 6

Column 3a

Additional risk control measures are required when the RPN indicated in column
less, enter "NA" in the column

Column 3b

S=Severity
may reduce 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 addition
up date.

Column 3f

Enter any remarks

Note 1:
ext review date for the RA. Normally the next review date is
The RA is also
(1) When there are
(2) After any
Note 2: Check your
RA

e used.

Note:
Therefore, a computer

out.
mechanical, physical, ergonomics, psychosocial, slip & fall etc.

entified hazard.
burns, frost bites, fractures etc.

Examples of

liminate or minimise risks.

Methods to
Controls: Elimination, Substitution, Engineering Controls,
(PPE).
Elimination of the hazard should take first

ased solvents instead of organic based solvents

c solvent

me cupboard or gloves boxes

s. Good laboratory practices. Training on proper use of chemicals

yewear plus respiratory protection, use of gloves

Severity is
azards, or as a result of an accident. Choose the most likely
most extreme.
Refer to the Risk Matrix tab for

Likelihood of
ed as the probability that the said accident, incident or ill
between 1 and 5. Consider the records of such events
Refer to the Risk Matrix tab for the

RPN=Severity
All RPNs should not

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

asures

al control measures

ol measures

lementation of the additional control measures. Enter the follow-

Risk Assessment Matrix

Risk Prioritisation Number = Severity x Likelihood
Severity Table
Pt

Severity level

Workplace Safety
Fatality,
single or multiple

Critical

Workplace Health

Environment

Fire Damage

Acute Poisoning,
Failure of Major Bodily Spills to Outside Campus
Functions

Permanent Body
Injury or Loss of Use
for more than 30 days

Infection with No
Known Cure

Infection - outside
Campus area

Injury requiring 30 days

of hospitalisation and/or
medical leave

Moderate exposure,
Reversible injury to
Bodily Functions on
prolong recovery

Spills to Outside Building

Temporary Body Injury

or Loss of Use for more
than 10 days but not
exceeding 30 days

Infection with Known

Cure but extensive
treatment

Infection - outside
Building area but within
Campus

More Than $10

million damages

More Than $1 million

damages

Very Serious

Serious

Mild exposure,
Injury requiring 10 days
Reversible injury to
of hospitalisation and/or Bodily Functions with
medical leave
less than 30 days
recovery

Spills to Outside
Laboratory/Room

Temporary Body
Injury or Loss of Use
for up to 10 days

Infection with Known

Cure but extensive
treatment

Infection - outside
Laboratory area but
within building

Injury requiring
maximum of 3 days of
medical leave only

Very Mild exposure,

Reversible injury to
Bodily Functions with
less than 3 days
recovery

Spills to Outside
Workplace but within
laboratory

Temporary Body
Injury or Loss of Use
for 3 days or less

Infection with Known

Cure but treatment
needed

Infection - outside
workplace but within
Laboratory

First aid treatment only

Very Mild exposure,

Reversible injury to
Bodily Functions with
less than 3 days
recovery

Spills within Workplace

only

No or superficial injury

No Exposure

No Infection or infection
with no effects within
workplace

Marginal

Negligible

More Than $100k

damages

More Than $10k

damages

Less than $5k

damages

Likelihood Table
Pt

Likelihood level

Likelihood of Occurrence / Exposure Criteria

Frequent

Likely to occur many times per year

Moderate

Likely to occur once per year

Occasional

Might occur once in three years

Remote

Might occur once in five years

Unlikely

Might occur once in ten years

Risk level Determination - 5 x 5 Matrix

LIKELIHOOD

SEVERITY
Critical
(5)

Very Serious
(4)

Serious
(3)

Marginal
(2)

Frequent
(5)

25
Operation not
permissible

20
Operation not
permissible

15
High priority

10
Review at
appropriate time

Moderate
(4)

20
Operation not
permissible

16
Operation not
permissible

12
High priority

8
Review at
appropriate time

Occasional
(3)

15
High priority

12
High priority

9
Review at
appropriate time

6
Risk acceptable

Remote
(2)

10
Review at
appropriate time

8
Review at
appropriate time

6
Risk acceptable

4
Risk acceptable

Unlikely
(1)

5
Risk acceptable

4
Risk acceptable

3
Risk acceptable

2
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

experimentation.
High priority remedial action

12 - 15

Warning

Proceed with extreme caution with PI present at a

Implement additional (secondary) controls immedia
within 7 days. Emergency control measures shall b

Take remedial action at appropriate time

8 -10

Medium

Proceed with care. Additional control is advised. Rev

implemented within 30 days.

Risk acceptable: Residual risk

1-6

Warning

If possible, risk reduction should be further considered

severity.

There are no imminent dangers. Frequent review sha

especially changes in procedures, materials or env

ia

Downtime Incurred
More than 1 year for full
re-instatement

More than 3 months for

full re-instatement

More than 1 month for

full re-instatement

More than 5 days for full

re-instatement

No significant downtime

Negligible
(1)

5
Risk acceptable

4
Risk acceptable

3
Risk acceptable

2
Risk acceptable

1
Risk acceptable

ion

t Permissible

ontrols. If necessary abort

ntation.

emedial action

n with PI present at all times.

y) controls immediately. Review
rol measures shall be in place.
at appropriate time

ntrol is advised. Review shall be

within 30 days.

e: Residual risk

be further considered, particularly

rity.

Frequent review shall be in place

es, materials or environment.

RISK ASSESSMENT FORM

School / Department & Exact Location Of The Work Performed:
(Example: SPMS -PAP - Lab A)

Project / Work Description: Working with Femtosecond L

Risk Assessment Team (Name/s): Johnny (Team Leader), Alice, Roland, Kenny

Approved By Supervisor / Reporting Officer:

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

Date Conducted: 11th March 2012

Next Review Date: 10th March 2013

Hazard Identification

Risk Evaluation

1a.

1b

1c.

1d.

2a.

2b.

2c.

2d.

3a

3b

S/N

Work activity

Hazard

Possible Accident/ Ill

health to persons, fire
or property loss

Existing Risk
Control

Severity

Likelihood

RPN*

Additional Risk
Control
Measures

Severity

1 Operation of Femtosecond Laser

Systems

Beam blocks and

beam dumps used
to blocked off laser
beams.
Only
authorised users
are allowed to
operate the
system.
Users are
equipped with
laser goggles

Physical Hazard

Severe Eye Injuries

Electrical Hazard

Electrocution due to high Warning signs are

voltage
displayed beside
system to warn
users of high
voltage

6 NA

12 Regular servicing
and maintenance
of laser system by
vendor
Only authorised
users are allow to
operate the
system

NA

*RPN - Risk Prioritization Number

mtosecond Laser Systems

r:

012

Risk Control
3c

3d

3e

3f

Likelihood

RPN*

Follow up by (name) &

date

Remarks

NA

NA

NA

4 (Johnny) 13th March 2012

NA

NA

RISK A
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
1a.

1b

1c.

1d.

S/N

Work activity

Hazard

Possible Accident/ Ill

health to persons, fire
or property loss

1 Weighing chemicals for the synthesis

work

2 Prepare glassware and add

chemical into chemical reactor

Irritant Chemicals

Irritation when come in

contact with skin and
eyes

Glass breakage due Cuts on skin/eye due to

to overpressure
flying particles
(chemical reaction)

*RPN - Risk Prioritization Number

RISK ASSESSMENT FORM

Project / Work Description: Chemical works
Approved By Supervisor / Reporting Officer:
(Name, Date & Signature)
Prof Xiao (Project Supervisor), 16th March 2012

Date: 10th March 2013

Risk Evaluation

Risk Control

2a.

2b.

2c.

2d.

3a

3b

3c

Existing Risk
Control

Severity

Likelihood

RPN*

Additional Risk
Control
Measures

Severity

Likelihood

NA

NA

NA

Handle under
fumehood.
Put on required
PPE - safety
glasses, lab coat,
long pants, gloves,
covered shoes.

Inspect glassware
before use.
Put on required
PPE - safety
glasses, lab coat,
long pants, gloves,
covered shoes.

9 Install pressure
control / relief
valves
Supervisor to brief
group to pull down
fumehood sash

Risk Control
3d

3e

3f

RPN*

Follow up by (name) &

date

Remarks

NA

NA

(Benny) Ongoing

NA

NA

RISK A
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

1a.

1b

1c.

1d.

S/N

Work activity

Hazard

Possible Accident/ Ill

health to persons, fire
or property loss

Sorting of documents / Use of paper

Contact with sharp

edges (from paper
edges and bent
plaster dividers

Punching holes for document to Strike by moving

parts or caught
be filed
between moving
parts

Cuts and lacerations to

hand and fingers

Fingers may get injured

(crush) during punching

Ergonomic hazard
(repetive similar
action)

*RPN - Risk Prioritization Number

Muscular starins

RISK ASSESSMENT FORM

Project / Work Description: General Office Activities
Approved By Supervisor / Reporting Officer:
(Name, Date & Signature)
Mr Lim (Manager), 16th March 2012

Date: 10th March 2013

Risk Evaluation

Risk Control

2a.

2b.

2c.

2d.

3a

3b

3c

Existing Risk
Control

Severity

Likelihood

RPN*

Additional Risk
Control
Measures

Severity

Likelihood

Handle files and

documents with
care, avoiding
fingers running
along the edge of
papers.
Discard bend
plastic folders.

Provide finger cots 1

to staff to lift
paper

Proper usage of
1
hole punch
Do not overload
paper for punching

NA

NA

Maintenance of
hole puncher

NA

Staff to adopt
3
good ergonomice
practice e.g. table
height.
Job
rotations; avoid
prolong repetitive
punching
operation.
Brief staff on
proper usage of
hole punch.

NA

NA

NA

Risk Control
3d

3e

3f

RPN*

Follow up by (name) &

date

Remarks

Office Staff (April 2012)

NA

NA

NA

NA

NA

NA

NA