Basic Risk Assessment Template

• Conducted on

  Date

• Prepared by

• Location
  Address

General

• Enter description of procedure, task or worksite being assessed

Hazards, Risks and Controls

• Click Add Hazard (+) after you have observed and identified a hazard

Hazard

• Identify the task

• What are the risks associated with each activity?

• Photo of hazard (optional)

  Media

• Risk rating

  High

  Medium

  Low

• Select control measures (include notes)

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

  • Elimination
  • Substitution
  • Engineering Controls
  • Administrative Controls
  • PPE
  • Other

• Enter other control measures

Completion

• Recommendations

• Signature

  Sign