CAFCASS Work Related Stress Risk Assessment Form

Appendix B – Assessment of Risk

Use this form to identify the range of hazards that may be present in the stated work activity and to establish whether sufficient control measures exist to comply with relevant statutory provisions.

Office Address:
Description of activity: / Duties undertaken in following the full range of CAFCASS job descriptions.
Estimate the risk of injury

Hazard (What might go wrong?)

/ Who might be harmed? / What controls are in place to prevent harm? / Likelihood rating-L / Severity rating-S / Risk rating-R / Residual risk code A/M/I
1 / Demands
2 / Control / .
3 / Role
4 / Support
5 / Relationships / .
6 / Change.

For rating scores of 1 – 6 indicate “A”, for rating scores of 8 – 12 indicate “M”, for rating scores of 15 – 25 indicate “I”. (For “A”’s, no further action is required, for “M”’s & “I”’s additional control measures are to be listed on part B) .

Part B – Action Plan

Enter any additional control measures required to reduce the risk against each hazard to an “Acceptable (A)” level.

Haz No. /

Risk code

M/ I

/

Additional control measures or actions required

/ Date of action completion / Revised ratings / Revised Residual risk code /

Actions

Signed off by:

L

/ S / R / A/M/I
Assessor Name (Print): / …………………………. / Date of assessment / …………………. / Date of assessment review / ……………………..

If a trade union representative took part in this assessment, enter their name and union here:

Name (Print): / ………………………… / Trade Union Body: / …………………………
Assessment signed off by:
(Line Manager) / …………………………… / Date / …………………………

Health and Safety Risk Estimation and Matrix charts.

Rating Value / Likelihood of hazard happening / Description
5 /

DEFINITE

/ Will happen immediately or in the very near future.
4 / PROBABLE / Likely to happen.
3 / POSSIBLE / Could happen sometime.
2 / REMOTE / Very Unlikely to happen.
1 / IMPROBABLE / Inconceivable that this could happen

Severity ratings and guideline descriptions: XLikelihood ratings and guideline descriptions:

Rating Value / Severity of hazard / Description
(Reasonably foreseeable worst case injury)
5 / CATASTROPHIC / Hazard is capable of causing death.

4 / MAJOR / Hazard can result in serious illness or severe long term injury.
3 / MARGINAL / Hazard could cause lost time through illness or injury. External treatment would be required.
2 / MINOR / Slight injury. Possibly first aid treatment required.
1 / NEGLIGIBLE / Little consequence. Not expected to cause ill health or injury.

Risk Matrix:Key for risk matrix

5 / 5 / 10 / 15 / 20 / 25
4 / 4 / 8 / 12 / 16 / 20
3 / 3 / 6 / 9 / 12 / 15
2 / 2 / 4 / 6 / 8 / 10
1 / 1 / 2 / 3 / 4 / 5
1 / 2 / 3 / 4 / 5