Information
-
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?
- Staff
- Client/Visitors
- Everyone
Description
-
Advise description of risks
Risk rating
-
Severity
-
Probability of occurance
-
Risk rating
-
Reference: Risk Matrix
Existing Measures
-
Were there any existing measures in place to control this risk?
-
Please detail existing measures
Resolution
-
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?
Completion
-
Risk assessment has been completed
-
Risks reported have been resolved and completed
-
Signature