General Risk Assessment Template

• Conducted on

  Date

• Prepared by

• Company Location
  Address

• Work Area

  Select Cutting & Blasting Delta Cell Sub-Assembly Main Assembly Paint Booth Skid Assembly Vessel Dept. Shipping Machineing Warehouse Other

  • Cutting & Blasting
  • Delta Cell
  • Sub-Assembly
  • Main Assembly
  • Paint Booth
  • Skid Assembly
  • Vessel Dept.
  • Shipping
  • Machineing
  • Warehouse
  • Other

• Name of Work Area

General

• Enter description of procedure or job task.

Identified Hazard.

Hazard

• Description of Hazard

• Photo of Hazard

  Media

Initial risk rating

• Initial Consequence

  Select Fatality Major Injuries/Hospitalization Minor Injuries/Dr. Visit Negligible Injuries/First Aid Only

  • Fatality
  • Major Injuries/Hospitalization
  • Minor Injuries/Dr. Visit
  • Negligible Injuries/First Aid Only

• Initial Likelihood

  Select Very Likely Likely Unlikely Highly Unlikely

  • Very Likely
  • Likely
  • Unlikely
  • Highly Unlikely

• Initial Risk Rating

  Select High Medium Low

  • High
  • Medium
  • Low

Controls

• Select Control Measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

  • Elimination
  • Substitution
  • Engineering Controls
  • Administrative Controls
  • PPE
  • Other

• Enter Other Control Measures

Residual risk rating

• Residual Consequence

  Select Fatality Major Injuries/Hospitalization Minor Injuries/Dr. Visit Negligible Injuries/First Aid Only

  • Fatality
  • Major Injuries/Hospitalization
  • Minor Injuries/Dr. Visit
  • Negligible Injuries/First Aid Only

• Residual Likelihood

  Select Very Likely Likely Unlikely Highly Unlikely

  • Very Likely
  • Likely
  • Unlikely
  • Highly Unlikely

• Residual Risk Rating

  Select High Medium Low

  • High
  • Medium
  • Low

References

• Risk Matrix Reference

  

• Hierarchy of Controls Reference

  

Completion

• Recommendations

• Inspector's Full Name & Signature

  Sign