Title Page
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Conducted on
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Prepared by
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Location
General
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Enter description of procedure, task or worksite being assessed
Hazards, Risks and Controls
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Click Add Hazard (+) after you have observed and identified a hazard
Hazard
Hazard
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Description of hazard
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Photo of hazard (optional)
Initial risk rating
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Initial consequence
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Initial likelihood
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Initial risk rating
Controls
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Select control measures
- Elimination
- Substitution
- Engineering Controls
- Administrative Controls
- PPE
- Other
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Enter other control measures
Residual risk rating
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Residual consequence
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Residual likelihood
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Residual risk rating
References
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Risk Matrix Reference
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Hierarchy of Controls Reference
Completion
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Recommendations
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Inspector's Full Name & Signature