Title Page

  • Conducted on

  • Prepared by

  • Location

Information

  • Disclaimer

    The assessors believe the information contained within this risk assessment report to be correct at the time of printing. The assessors do not accept responsibility for any consequences arising from the use of the information herein. The report is based on matters which were observed or came to the attention of the assessors during the day of the assessment and should not be relied upon as an exhaustive record of all possible risks or hazards that may exist or potential improvements that can be made.

  • Confidentiality Statement

    In order to maintain the integrity and credibility of the risk assessment processes and to protect the parties involved, it is understood that the assessors will not divulge to unauthorized persons any information obtained during this risk assessment unless legally obligated to do so.

This part is for IPC

  • IPC Notes

  • Action Done by IPC Practitioner

  • Signature

This report will be sent to Hospital Director and/or Medical Director and Copy to the Department Direct Director

  • For Department Director after receiving a copy of the report immediate action is required

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.