• Site name

  • Conducted on

  • Prepared by

  • Location

Work Activity

  • Advise the work activity that appears to be a risk

  • Enter details of activity

Hazards Identified

  • List all the hazards identified in relation to the particular activity

  • Take picture of hazard if possible

Who might be harmed?

  • Who can be harmed or affected by these risks?


  • Advise description of risks

Risk rating

  • Severity

  • Probability of occurance

  • Risk rating

  • Reference: Risk Matrix

    Screen Shot 2018-05-21 at 11.14.28 am.png

Existing Measures

  • Were there any existing measures in place to control this risk?

  • Please detail existing measures


  • Indicate if this risk can be controlled immediately or not

Implementation Plan

  • Enter description of implementation plan

  • List who will be responsible for actioning the implementation plan

  • When will this be actioned and completed by?


  • Risk assessment has been completed

  • Risks reported have been resolved and completed

  • Signature

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.