General Risk Assessment version 1.1

• Audit Title

• Document No.

• Shipping Company

• Conducted on

  Date

• Prepared by

Note - Risk assessments should be updated annually or whenever the activity changes.

Date

• Date and time of the risk assessment?

  Date

Identified risk 1

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 2

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 3

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 4

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 5

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 6

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 7

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 8

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 9

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Identified risk 10

Task element?

• Description of task

Hazard

• Type of hazard

  Select Slip Trip Fall Electrical Other

  • Slip
  • Trip
  • Fall
  • Electrical
  • Other

• State if other......

Who is at risk?

• Who is at risk?

  Select Employees Contractors Visitors

  • Employees
  • Contractors
  • Visitors

Initial risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Counter measures to be taken

• Countermeasures to be taken.

Final risk level

• Risk Severity

  1

  2

  3

  4

• Frequency

  1

  2

  3

  4

• Risk level (Severity x frequency)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16

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

  High

  Medium

  Low

Signing off

• Risk assessor signature

  Sign

• Masters signature

  Sign

• DPA signature

  Sign

• Date of re-assessment

  Date