Title Page
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Site
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Vendor
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Conducted on
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Officer in Charge
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Location
Overview
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Description of procedure, task or worksite being assessed
Risk Matrix and Hierarchy of Controls
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Risk Matrix Reference:
Risk/ Hazard Register
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Risk
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Description of risk/ hazard
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Photo of hazard (optional)
Risk Rating
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Consequences
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Likelihood
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Risk Rating (refer risk matrix above)
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Comments/ observations
Completion
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Recommendations
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Officer in charge (Full Name and Signature)