Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Section 1
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Site
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Location
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Reported by
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Reported to
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Select date
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Description of hazard
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Risks posed by hazard
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Legislative Reference
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Current controls
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Interim actions
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Who has been Consulted?
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Section 2
Risk potential- risk analysis-risk calculator including current controls -
Consequence(c)<br>Severity of injury/illness
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Exposure (E)<br>(Frequency & duration)
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Probability<br>(Likelihood of C+E)
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Total (Consequence X Exposure X Probability)
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Section 3
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Possible Controls
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Risk control plan (Preferred controls)
- Elimination
- Substitution
- Isolation
- Engineering
- Administrative
- PPE
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By whom
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By when
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Completed date
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Completed (Sign off)
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Any legislative requirements ?
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Safety Alert required
- Yes
- No
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Residual risk priority (Consequence X Exposure X Probability)
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Section 4
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Originator notified of action taken (Completed-sign off)
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Date of sign off
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Controls monitored for their completion,effectiveness and do not introduce any further risk (Completed-sign off)
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Date of sign off
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Record filed and database updated (Completed-sign off)
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Date of sign off
