GSH Risk Assessment audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

List the area(s)of concern.

• Safe

  At Risk

  N/A

List the concerns in this area(s).

• Yes

  No

  N/A

Who is affected by this concern?

• Yes

  No

  N/A

Will it cost the organization anything to fix the problem?

• Yes

  No

  N/A

If yes, how much? (Any amount over $500.00 must be approved by Mr. Carter first.)

• Yes

  No

  N/A

Is it feasible to fix this at this time? If no, then please explain below.

• Yes

  No

  N/A

What is the plan of action to correct this concern?

• Yes

  No

  N/A

List a estimated completion time on fixing the concern.

• Yes

  No

  N/A

Persons approving this risk assement

• Yes

  No

  N/A

• Add signature

  Sign

• Add signature

  Sign