Line Manager

Role Risk Assessment Acknowledgement

Type Of Role Risk Assessment?

Have you read and understood your Role Risk Assessment?

Are there any additional health and safety controls required?

If NO then please go to Task Risk Assessment section

If YES then you must arrange a meeting with your line manager to discuss and document any additional controls required and ensure that they are in place prior to starting work.

Managers must ensure that risk assessments record all significant risks relevant to the role, activity or workplace. Where further control measures are required to reduce the risk to allow safe working a prioritised Action Plan must be completed and where necessary the activity stopped until actions have been completed.

Task based Risk Assessments

Have you read and understood the task based risk assessments relevant to your role?

Please list the document numbers of all task based risk assessments that you have read and understood

I understand the selected Role Risk Assessment above and the Task Based Risk Assessments that I have listed . I consider these to be suitable and sufficient to control the risks to my health and safety and other persons who may be affected by the work activities.
I agree that I will follow the procedures that have been put in place for my safety.
I will inform my Line Manager of any additional hazards that arise as soon as possible to ensure that further measures can be considered to reduce the risks to my health and safety.

Add signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.