NHSE FOR 018 Risk Assessment Form

• Document No.

• Risk Assessment Title

• Location / Section

• Task definition

• Conducted on

  Date

• Prepared by

• Relevant Personnel

Document Control

• Initial assessment date

  Date

• Task Number

• Highest residual risk score

• Assessor name

• Signature

  Sign

• Manager name

• Signature of acceptance

  Sign

• Associated safe system of work / Associated manual handling assessment / Associated COSHH assessment

Review and Amendment History

• Review date due

  Date

• Review carried out

Review

• Review carried out date

  Date

• Risk Ranking Number

• Amendments made

• Assessor name

• Signature

  Sign

• Manager name

• Signature of acceptance

  Sign

Part 2 : Risk Assessment

• Risk details

Risk

• Reference Number

• Hazard Identified

• Add media

  Media

• What could happen ?

• Persons Affected

• Existing Controls

• Likelihood

• Consequence

• Total risk LxC

• Proposed Additional Controls

• Likelihood

• Consequence

• Total risk LxC

Part 3 : Action Plan Index

• Section

• Task Number Description

• Managers Name

• Risk action

Risk Number

• Original Risk Rank

• Hazards

• Action Date Required and person responsible

• Required Date

  Date

• Managers comments

• Date completed

  Date

• L x C = residual risk ranking