Title Page

  • Prepared by

  • Location
  • Date of Assessment

  • Proposed Review Date

Company Details

  • Company Name:

  • Address:

  • Contact Name:

  • Tel No:

  • Email:

Assessors Details

  • Name of Assessor:

  • Tel No.

  • Email:

Introduction

  • General Information and brief description of activities covered by this assessment:

Assessment

    Hazard
  • Hazard Identified

  • Who Might be Harmed and How?

  • Existing Measures to control risk and general comments

  • Risk Rating (Consider Likelihood and Severity)

  • Risk Adequately Controlled?

  • See Action Plan at the end

Action Plan

  • Are Further Actions required?

  • Action
  • Hazard Reference Number

  • Further Action Required

  • Action by whom

  • Implementation Date

  • Comments

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.