Dynamic Risk Assessment Template

• Site

  Select

• Conducted on

  Date

• Prepared by

• Name of people involved in the assessment

• Location
  Address

General Details

• Description of task or worksite being assessed

Hazards and Risks

• Photograph the area to show safe or unsafe?

Details on Risks

• Description of observed risk

• Attach photos of hazard

  Media

• Identify type of hazard

  Physical

  Biological

  Organizational

  Chemical

  Safety hazard

• Identify risk level

  Low

  Medium

  High

• Risk severity

  Acceptable

  Tolerable

  Undesirable

  Intolerable

• Likelihood of risk

  Likely

  Very Likely

• Persons at risk

Job Commencement

• Are you satisfied that you have reduced all known risks?

  Yes

  No

  N/A

• Are you satisfied that this task can be completed in a safe manner?

  Yes

  No

  N/A

• Are you satisfied that you have the correct tools to conduct this task in the correct manner?

  Yes

  No

  N/A

• Are you satisfied that you have the correct PPE available to conduct this task?

  Yes

  No

  N/A

• Are you satisfied that there is no risk to you or your colleagues by conducting this task?

  Yes

  No

  N/A

Safety Systems

• Department(s) involved in implementing safety

• What needs to be done? SSoW? Risk Assessment? etc.

• Is there a need for extra safety measures?

  Yes

  No

• Identify needed control measure

  Select PPE Specialized equipment and machinery Formal training Other

  • PPE
  • Specialized equipment and machinery
  • Formal training
  • Other

• Specify

Completion

• Additional comments and recommendations

• Risk assessed and safe to start? (Full Name & Signature)

  Sign