Title Page

  • Conducted on

  • Prepared by

  • Company Location
  • Work Area

  • Name of Work Area


  • Enter description of procedure or job task.

  • Identified Hazard.


  • Description of Hazard

  • Photo of Hazard

Initial risk rating

  • Initial Consequence

  • Initial Likelihood

  • Initial Risk Rating


  • Select Control Measures

  • Enter Other Control Measures

Residual risk rating

  • Residual Consequence

  • Residual Likelihood

  • Residual Risk Rating


  • Risk Matrix Reference

    Screen Shot 2018-05-21 at 11.14.28 am.png
  • Hierarchy of Controls Reference

    OSH toolkit noise - hierachy of controls.jpg


  • Recommendations

  • Inspector's Full Name & Signature

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.