Psychosocial Risk Assessment Template ===================================== Purpose ------- Use this worksheet to document the four-step risk-management process required by the Model Code of Practice: Managing psychosocial hazards at work (Safe Work Australia, 2022) and WorkSafe WA's Psychosocial hazards in the workplace Code of Practice (2025). Capture who you consulted, the hazards identified, how you assessed consequence and likelihood, the controls you selected, and the evidence kept for inspectors. Page 1 — Assessment summary --------------------------- Organisation: ______________________________________________ Business unit / site: ________________________________________ Assessment owner: __________________________________________ Consulted HSRs / worker groups: ______________________________ Date commenced: ______________ Target review date: __________ Trigger / reason for assessment (e.g. planned review, incident, change): _____________________________________________________________________ Key references reviewed (tick): [ ] Model Code of Practice (Safe Work Australia) [ ] WA Psychosocial hazards Code (WorkSafe WA) [ ] NSW Managing psychosocial hazards Code of Practice [ ] QLD Managing the risk of psychosocial hazards Code of Practice 2022 [ ] Organisational policies or procedures Page 2 — Step 1 Identify hazards -------------------------------- List each psychosocial hazard, the cohorts affected, and the information sources you relied on (consultation, Echo voice check-ins, incident reports, absenteeism, grievances, etc.). | Hazard (e.g. high job demands, low support, remote work) | Cohort / location | Evidence & consultation notes | Existing controls | | -------------------------------------------------------- | ----------------- | ----------------------------- | ---------------- | | | | | | | | | | | | | | | | Record how hazards may interact (e.g. remote work + poor support, violence + inadequate staffing): _____________________________________________________________________ Page 3 — Step 2 Assess the risk (when required) ----------------------------------------------- Describe the likelihood and consequence ratings for each hazard. Note assumptions, uncertainty, and factors such as duration, frequency, and severity of exposure. Risk matrix (adapt to your organisation's ratings): | Insignificant | Minor | Moderate | Major | Catastrophic ------------|---------------|-------|----------|-------|-------------- Rare | Low | Low | Medium | Medium| High Unlikely | Low | Low | Medium | High | High Possible | Low | Medium| Medium | High | Extreme Likely | Medium | Medium| High | High | Extreme Almost sure | Medium | High | High | Extreme| Extreme | Hazard | Consequence rating | Likelihood rating | Risk level | Notes / evidence | | ------ | ------------------ | ----------------- | ---------- | ---------------- | | | | | | | | | | | | | Page 4 — Step 3 Control the risk -------------------------------- Outline the controls selected to eliminate or minimise each hazard so far as reasonably practicable. Consider work design, staffing, supervision, training, safe environments, and support services. Document why controls were chosen and how they address combined hazards. | Hazard | Control measures (hierarchy applied) | Implementation owner | Due date | Consultation / communication plan | | ------ | ------------------------------------ | -------------------- | -------- | --------------------------------- | | | | | | | | | | | | | Additional controls for remote or isolated work (communication, buddy systems, movement records): _____________________________________________________________________ Page 5 — Step 4 Review and evidence log --------------------------------------- Plan how you will monitor controls, who will verify effectiveness, and what evidence you will keep for inspectors (records of consultation, action completion, roster updates, toolbox talks, etc.). Review triggers (e.g. incident, worker feedback, regulatory change): _____________________________________________________________________ | Review date | Person responsible | Findings | Actions required | Evidence stored (location) | | ----------- | ------------------ | -------- | ---------------- | --------------------------- | | | | | | | | | | | | | Consultation evidence log: - Meetings / toolbox talks held: ______________________________________________ - Worker representatives consulted: __________________________________________ - Communications issued (emails, briefings, intranet): _________________________ Inspector-ready attachments (tick when filed): [ ] Completed risk assessment matrix [ ] Action plan with owners and deadlines [ ] Toolbox talk or shift briefing records [ ] Rosters / staffing plans showing workload controls [ ] Incident and grievance summaries [ ] Review findings and sign-off by PCBU/Officers Page 6 — Sign-off ------------------ PCBU / officer approval: ___________________________________ Date: __________ Health and safety representative acknowledgement: __________ Date: __________ Next scheduled review: _____________________________________