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Audit Program Area:
Auditor
AUDIT PROCEDURES WP Ref Initials
Time Date Date Checked
Spent Expected Finished Remarks By:
 Client Name
Internal Control Framework

Date Completed:
Completed By:
Reviewed By:

Question Yes No* Comments /Description

To the best of my knowledge, the answers and comments noted above are accur
internal controls within this department:

* For a “No” answer, cross-reference to either a compensating control or to audit work which has been performed
Questionnaire
or is to be performed.
 Name and Title of Person Completing Form (please print) Name and Title of Department Direc

Signature of Person Completing Form Signature of Department

3/17/2019
Date Form Completed Date of Department Director'

* For a “No” answer, cross-reference to either a compensating control or to audit work which has been performed
Questionnaire
or is to be performed.
 Employee Responsible for Task

s noted above are accurate and reflect the current

this department:

* For a “No” answer, cross-reference to either a compensating control or to audit work which has been performed
Questionnaire
or is to be performed.
Name and Title of Department Director (please print)

Signature of Department Director

Date of Department Director's Signature

* For a “No” answer, cross-reference to either a compensating control or to audit work which has been performed
Questionnaire
or is to be performed.
 Consequences
1 – Insignificant

Dealt with by in-

house first aid,
etc.

Almost certain to occur in most

Likelihood A - circumstances High (H)
B- Likely to occur frequently Moderate (M)
Possible and likely to occur at some
C- time Low (L)

D- Unlikely to occur but could happen Low (L)

May occur but only in rare and
E- exceptional circumstances Low (L)

How
OncetothePrioritize
level of the
riskRisk
has Rating
been determined the following table may be of use in determining when to act to
institute theAct
control measures.
immediately to mitigate the risk.Either eliminate, substitute or implement engineering control
Extreme measures.
Act immediately to mitigate the risk. Either eliminate, substitute or implement engineering control
High measures.
If these controls are not immediately accessible, set a timeframe for their implementation and
establish interim
established mustrisk reduction
be based strategies
on risk. At thefor
endtheofperiod of the
the time, setrisk
if the timeframe.
has not been addressed by
Medium elimination, substitution or engineering controls a further risk assessment must be undertaken.

term. Permanent controls may be administrative in nature if the hazard has low frequency, rare
Low likelihood and insignificant consequence.
Hierarchy of Control Controls identified may be a mixture of the hierarchy in order to provide minimum
operator exposure.
Elimination
Substitution
Engineering Controls
Administrative Controls
Personal Protective Equipment
 2 – Minor 3 – Moderate 4 – Major 5 – Catastrophic
Medical help needed.
Treatment by medical
professional/hospital Significant non-permanent Extensive
outpatient, etc. injury. permanent injury Death.
Overnight hospitalization (e.g. loss of Permanent disabling
(inpatient) finger/s) injury
Extended hospitaliz(e.g. blindness, loss of hand/s, quadriplegia)

High (H) Extreme (X) Extreme (X) Extreme (X)

High (H) High (H) Extreme (X) Extreme (X)

Moderate(M) High (H) Extreme (X) Extreme (X)

Low (L) Moderate(M) High (H) Extreme (X)

Low (L) Moderate (M) High (H) High (H)

be of use in determining when to act to

itute or implement engineering control allow scope for the use of administrative controls or PPE , even in the
titute or implement engineering control short
An term.
achievable timeframe must be established to ensure that
eframe for their implementation and elimination, substitution
determining or engineering
the timeframe. A timeframecontrols arethan
of greater implemented.
6 months would
,the setrisk
if the timeframe.
has not been addressed by generally not be acceptable for any hazard identified as high risk.
isk assessment must be undertaken.
Interim measures until permanent solutions can be implemented:
if the hazard has low frequency, rare · Developsupervision
Provide administrative
andcontrols
specific to limit the
training use or
related to access.
the issue of
concern. (See Administrative Controls below)
erarchy in order to provide minimum

Eliminate
Provide anthe hazard. that is capable of performing the same task and
alternative
is safer to use.
Provide
with or construct
employees, a physical
to mitigate thebarrier or guard.
risk. Provide training, instruction and
supervision about the hazard.
Personal equipment designed to protect the individual from the hazard.
f hand/s, quadriplegia)
 RISK ASSESSM

Topic:

Identify Hazards and subsequent Analyze Risks

Risks Evaluate Risks
Hazards/Issues/Risks Consequence Likelihood
K ASSESSMENT SUMMARY

Date:

Identify and evaluate existing risk controls

Risk level What we are doing now to manage this risk. Effectiveness of our strategies
 Review
Issue No.
date:

Further Risk Treatments

Further action needed

New risk level
Opportunities for improvement
Finding Ref # Control Testing Finding
Management Response & Treatment