Risk Assessment

Note - Risk assessments should be updated annually or whenever the activity changes.
Date
Date and time of the risk assessment?
Identified risk 1
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 2
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 3
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 4
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 5
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 6
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 7
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 8
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 9
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Identified risk 10
Task element?

Description of task

Hazard
Type of hazard

State if other......

Who is at risk?
Who is at risk?
Initial risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Counter measures to be taken

Countermeasures to be taken.

Final risk level

Risk Severity

Frequency

Risk level (Severity x frequency)

Risk evaluation (1-5= Low, 6-11 = Medium, 12-16 = High)

Risk 2

Signing off
Risk assessor signature
Masters signature
DPA signature
Date of re-assessment
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.