ESM General Risk Assessment

• Prepared by

• Location
  Address

• Date of Assessment

  Date

• Proposed Review Date

  Date

• 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)

  Low

  Medium

  High

• Risk Adequately Controlled?

  Yes

  No

• See Action Plan at the end

Action Plan

• Are Further Actions required?

  Yes

  No
Action

• Hazard Reference Number

• Further Action Required

• Action by whom

• Implementation Date

• Comments