Title Page

RISK ASSESSMENT

  • Title:

  • Risk Assessment No.

  • Project:

  • Location
  • Project No.

  • Date:

  • Assessor:

  • PART 1: RISK ASSESSMENT

  • Work Activity:

  • Details:

  • Main activity details:

  • Generic sub-activities:

  • Details:

  • Main Hazards:

  • Details:

  • Persons/Properties exposed:

  • Details:

  • Assessment of Risk

  • (a) Severity

  • (b) Likelihood

  • (a x b ) = Risk Score

  • 1 - 02 Low Risk - the work is safe and no further action is required unless additional hazards arise during the work

  • 03 - 06 Medium Risk - the work is safe, but the risk control measures need monitoring to ensure the risk level does not increase during the task or process. Prioritize And Control As Far As Reasonably Practicable

  • 07 - 15 High Risk - the risk controls need to be revieved and additional controls added to reduce the risk to medium level. Put Controls In Place Before Commencing To Reduce Risk Score

  • 16 - 25 Extreme High Risk - the activity should not proceed at this time due to the potential risk of a fatality and an alternative safer method of work is required before work can commence

  • PART 2: CONTROL MEASURES REQUIRED TO REDUCE THE RISK

  • Control Measures Required:

  • PPE:

  • PART 3: SUPPLEMENTARY RISK ASSESSMENT

  • Additional Persons/Property exposed:

  • Additional Specified Hazards Identified:

  • Details:

  • Maximum Number of People involved in the Activity

  • Frequency and duration of the activity:

  • Additional Control Measures Required:

  • Details:

  • Additional PPE Required:

  • All personnel MUST wear appriopriate level of PPE for the activity they are involved with or the area they are in.

  • PART 4: RESIDUAL RISK WITH CONTROL MEASURES APPLIED

  • Assessment of Residual Risk

  • (c) Severity

  • (d) Likelihood

  • (c x d) = Risk Score

  • 1 - 02 Low Risk - the work is safe and no further action is required unless additional hazards arise during the work

  • 03 - 06 Medium Risk - the work is safe, but the risk control measures need monitoring to ensure the risk level does not increase during the task or process. Prioritize And Control As Far As Reasonably Practicable

  • 07 - 15 High Risk - the risk controls need to be revieved and additional controls added to reduce the risk to medium level. Put Controls In Place Before Commencing To Reduce Risk Score

  • 16 - 25 Extreme High Risk - the activity should not proceed at this time due to the potential risk of a fatality and an alternative safer method of work is required before work can commence

  • PART 5: SIGN OFF

  • Received/Reviewed by:

  • Details:

  • Signature:

  • Select date

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