Title Page

  • Site

  • Conducted on

  • Prepared by

  • Name of people involved in the assessment

  • Location

Ad-Hoc Task - Dynamic Risk Assessment

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

  • Identify type of hazard

  • Identify risk level

  • Risk severity

  • Likelihood of risk

  • Persons at risk

Job Commencement

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

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

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

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

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

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?

  • Identify needed control measure

  • Specify

Completion

  • Additional comments and recommendations

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

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.