Title Page

  • Site

  • Vendor

  • Conducted on

  • Officer in Charge

  • Location

Overview

  • Description of procedure, task or worksite being assessed

Risk Matrix and Hierarchy of Controls

  • Risk Matrix Reference:

    risk_matrix.png

Risk/ Hazard Register

    Risk
  • Description of risk/ hazard

  • Photo of hazard (optional)

Risk Rating

  • Consequences

  • Likelihood

  • Risk Rating (refer risk matrix above)

  • Comments/ observations

Completion

  • Recommendations

  • Officer in charge (Full Name and Signature)

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