Regulatory Reform (Fire Safety) Order 2005, Fire Risk Assessment

• Audit Title

• Add media

  Media

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Part 1: GENERAL INFORMATION

The responsible person for fire safety

• Name of the responsible person

• Contact details of responsible person

1 The Building

• Number of above ground floors:

  Select 1 2 3 4 5 6 7 8 9 10

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

• Number of below ground floors:

  1

  2

  3

• Number of exits from below ground floors:

  1

  2

  3

• Is it possible to vent heat and smoke from the basement

  Safe

  At Risk

  N/A

• Is there access to the roof voids?<br>(Check for evidence of smoking, suitability of edge protection and roof lights)

  Safe

  At Risk

  N/A

• Floor area: (m2 per floor)

• Floor area: (m2 total)

• Brief details of construction: (Consider services, lift shafts, false ceiling voids, fire resisting materials and poorly fitting doors)

• Occupancy type:

• Curriculum activity in this building (Please detail activity by floor)

• Curriculum types in adjacent buildings (Consider fire spread from adjacent buildings)

2 The occupants

• Maximum number of occupants: (This is the maximum number of people possible to house in the building)

• Maximum number of occupants at any given time:

• Maximum number of members of the public at one time:

3 Occupants at special risk

• Are there sleeping occupants?

  Yes

  No

  N/A

• Are there adequate arrangements for the safe evacuation of sleeping occupants?<br>

  Safe

  At Risk

  N/A

• Are there disabled occupants?<br>(Consider sight, hearing and mobility issues)

  Safe

  At Risk

  N/A

• Are systems in place to alert and assist disabled occupants in the case of a fire?

  Safe

  At Risk

  N/A

• State locations of all refuge areas and details of suitability:

• Are evac chairs available?

  Safe

  At Risk

  N/A

• Can the lifts be used in an emergency by a disabled person?

  Safe

  At Risk

  N/A

• Are there occupants in remote areas?<br>(Basements, cellars, roof spaces, lift shafts, plant rooms)

  Safe

  At Risk

  N/A

• Are there any persons who work alone in the building?

  Safe

  At Risk

  N/A

• Are there any areas that may be remote due to out of hours working?

  Safe

  At Risk

  N/A

4 Previous Fire loss experience

• Can you confirm there has been no previous history of fire loss in the premises (give details if there has)

  Safe

  At Risk

  N/A

• Can you confirm there haven't been any fires in buildings next door, connected or in close proximity?

  Safe

  At Risk

  N/A

• Can you confirm there have been no near misses accidents involving fires?

  Safe

  At Risk

  N/A

• Have there been any fires or explosions which has resulted in closure of plant for more than 24hrs as reportable to RIDDOR.

  Safe

  At Risk

  N/A

• There has been NO escape of flammable gases or other flammable substances from the processes carried out on the premises?<br>(If there has please give details)

  Safe

  At Risk

  N/A

• Can you confirm there have not been any complaints regarding fire safety from staff, students, visitors or contractors?<br>(Please give details)

  Safe

  At Risk

  N/A

• Has there been any advice given regarding fire safety issues from any of the following sources?

• Fire authority, HSE/EHO<br>(Please give details)

  Safe

  At Risk

  N/A

• Union or non union safety reps<br>(Please give details)

  Yes

  No

  N/A

• General health and safety inspections

  Safe

  At Risk

  N/A

5 Other relevant background

• Is there a prohibition notice in force? (if yes give date of issue)

  Safe

  At Risk

  N/A

• Is there an alteration notice in force? (if yes give date of issue)

  Safe

  At Risk

  N/A

• Is there an enforcement notice in force? (if yes give date of issue and date of when work is to be completed by)

  Safe

  At Risk

  N/A

Part 2: FIRE HAZARDS AND ELIMINATION OR CONTROL

6 Electrical sources of ignition

• Are reasonable measures taken to prevent fires of electrical origin?

  Safe

  At Risk

  N/A

• Is the fixed wiring installation periodically tested and inspected by a competent person?

  Safe

  At Risk

  N/A

• Are portable appliances tested/inspected?

  Safe

  At Risk

  N/A

• Is there a suitable policy about the use of personal electrical appliances?

  Safe

  At Risk

  N/A

• Is there a suitable limitation on the use of trailing leads and adapters?

  Safe

  At Risk

  N/A

• Is all electrical equipment tested and records on site

  Safe

  At Risk

  N/A

7 Smoking

• Are reasonable measures taken to prevent fires as a result of smoking?

  Safe

  At Risk

  N/A

• Are there suitable arrangements made for those who wish to smoke?

  Safe

  At Risk

  N/A

• Is there absence of any evidence of breaches of smoking policy?

  Safe

  At Risk

  N/A

• Is the appropriate smoking prohibition notice displayed at the building's entrance?

  Safe

  At Risk

  N/A

8 Arson

• Does the basic security against arson appear reasonable?

  Safe

  At Risk

  N/A

• Is there sufficient control of unnecessary fire load in close proximity to the building or available for ignition by outsiders?

  Safe

  At Risk

  N/A

• Are there any records of any break in's to this or adjacent buildings?

  Safe

  At Risk

  N/A

• Are refuse areas sited away from buildings and are they adequately secured?

  Safe

  At Risk

  N/A

9 Portable heaters and heating installation

• Is the use of portable heaters avoided as far as reasonably practicable?

  Safe

  At Risk

  N/A

• If portable heaters are used, are the more hazardous types (radiant bars and LPG) avoided?

  Safe

  At Risk

  N/A

• If portable heaters are used, are suitable measures taken to minimise the risk of ignition of combustible materials?

  Safe

  At Risk

  N/A

• Have all portable heaters been PAT tested?

  Safe

  At Risk

  N/A

• Are emergency escape routes free from portable heaters?

  Safe

  At Risk

  N/A

• Are fixed heating installations subject to regular maintenance?

  Safe

  At Risk

  N/A

10 Cooking facilities

• What types of cooking appliances are in use on the premises?

  Select microwaves conventional ovens - gas conventional ovens - electric hot plates deep fat fryers grills toasters

  • microwaves
  • conventional ovens - gas
  • conventional ovens - electric
  • hot plates
  • deep fat fryers
  • grills
  • toasters

• Are there any kitchen tools/appliances that generate a flame (blow lamps)?

  Safe

  At Risk

  N/A

• Are reasonable measures taken to prevent cooking fires?

  Safe

  At Risk

  N/A

• Are filters changed and ductwork cleaned regularly?

  Safe

  At Risk

  N/A

• Are cooking appliances regularly maintained?

  Safe

  At Risk

  N/A

• Does regular cleaning take place to remove crumbs and other combustible materials?

  Safe

  At Risk

  N/A

• Are suitable extinguishers available?

  Safe

  At Risk

  N/A

11 Lightning

• Does the building have lightning protection system if required? (if yes has it been tested and are records of testing kept)

  Safe

  At Risk

  N/A

12 Other significant ignition sources that warrant consideration

• Are halogen lamps situated away from combustible materials?

  Safe

  At Risk

  N/A

• List other ignition sources:

13 Housekeeping

• Are combustible materials separated from ignition sources?

  Safe

  At Risk

  N/A

• Is the unnecessary accumulation of combustibles and waste avoided?

  Safe

  At Risk

  N/A

• Are combustible materials stored appropriately?

  Safe

  At Risk

  N/A

• Do inspection reports include details of standard of housekeeping?

  Safe

  At Risk

  N/A

14 Hazards introduced by contractors or in house building works

• Is there an approved list of contractors in use?

  Safe

  At Risk

  N/A

• Are contractors subject to pre-qualification and selection procedures?

  Safe

  At Risk

  N/A

• Are risk assessments and method statements approved prior to contractors coming on site?

  Safe

  At Risk

  N/A

• Is there sufficient control over works by contractors (e.g. Permits to work & hot works permits)?

  Safe

  At Risk

  N/A

• Are safety conditions and college instructions/procedures communicated to contractors?

  Safe

  At Risk

  N/A

• Do contractors control the hazardous substances that they bring on site

  Safe

  At Risk

  N/A

15 Dangerous Substances (DSEAR related)

• Are dangerous substances present on the premises?

  Safe

  At Risk

  N/A

• Are there procedures and safe storage in place for dangerous substances?

  Safe

  At Risk

  N/A

• Has the risk to relevant persons been adequately eliminated or reduced?

  Safe

  At Risk

  N/A

• Are there arrangements for the safe storage and use of compressed gas cylinders and piped systems?

  Safe

  At Risk

  N/A

• Are pyrotechnics used?<br>(If yes please give details including storage)

  Safe

  At Risk

  N/A

16 Hazardous Substances (COSHH related)

• Is there an inventory of hazardous substances kept in the building?

  Safe

  At Risk

  N/A

• Is there appropriate storage of hazardous materials?

  Safe

  At Risk

  N/A

Part 3: FIRE PROTECTION MEASURES

17 Means of escape

• Is the building provided with adequate means of escape in case of fire?

  Safe

  At Risk

  N/A

• Are there sufficient exits?

  Safe

  At Risk

  N/A

• Are exits easily and immediately openable where necessary?

  Safe

  At Risk

  N/A

• Do fire exits open in the direction of travel where necessary?

  Safe

  At Risk

  N/A

• Have sliding or revolving doors been avoided as fire exits?

  Safe

  At Risk

  N/A

• Are there adequate means of securing exits?

  Safe

  At Risk

  N/A

• Are there reasonable distances of travel where there is a single direction of travel?

  Safe

  At Risk

  N/A

• Are there reasonable distances of travel where there are alternative means of escape?

  Safe

  At Risk

  N/A

• Are escape routes adequately protected?

  Safe

  At Risk

  N/A

• Are there suitable fire precautions for all inner rooms?

  Safe

  At Risk

  N/A

• Are escape routes unobstructed?

  Safe

  At Risk

  N/A

• Are there suitable means of escape for disabled occupants?

  Safe

  At Risk

  N/A

• Are there any known obstructions to escape routes for disabled employees or visitors?<br>(Stairs, steps etc)

  Safe

  At Risk

  N/A

18 Measures to limit fire spread and development.

• Is there a sufficient standard of compartmentation and sub-compartmentation?

  Safe

  At Risk

  N/A

• Are linings that promote fire spread avoided as far as reasonably practicable?

  Safe

  At Risk

  N/A

• Are all services, particularly new ones being sealed with approved fire stopping?

  Safe

  At Risk

  N/A

• Have fire shutters/curtains been installed as part of the fire compartmentation?

  Safe

  At Risk

  N/A

• If shutter or curtain systems are installed are they manual or automatic?

  manual

  automatic

• Are shutters/curtains suitably maintained?

  Safe

  At Risk

  N/A

• Do any ceiling/wall voids prevent fire spread?

  Safe

  At Risk

  N/A

• Have false ceilings been avoided within the building?

  Safe

  At Risk

  N/A

• Are open stairways protected?

  Safe

  At Risk

  N/A

• Do all doors, particularly fire doors fit, seal and close properly?

  Safe

  At Risk

  N/A

19 Escape lighting

• Is there a reasonable standard of escape lighting provided?

  Safe

  At Risk

  N/A

• Does an emergency lighting operate effectively on failure of the normal power supply?

  Safe

  At Risk

  N/A

• Is an annual discharge completed on the emergency lighting system?

  Safe

  At Risk

  N/A

20 Fire safety signs and notices

• Are fire safety signs and notices suitable and sufficient?<br>(Signs should be of the same type)

  Safe

  At Risk

  N/A

• If lifts cannot be used in a fire is there suitable signage to indicate this?

  Safe

  At Risk

  N/A

• Are fire extinguishers, hose reels and other fire equipment points well signed?

  Safe

  At Risk

  N/A

21 Means of giving warning in the event of fire

• Is a manually operated electrical fire alarm system provided?

  Safe

  At Risk

  N/A

• Is the alarm system a single stage or linked fire alarm?<br>(Single - rings in whole building, linked - rings in main building and will ring in adjacent if detectors in particular areas are activated)

  Safe

  At Risk

  N/A

• Are all call points visible and unobstructed?

  Safe

  At Risk

  N/A

• Is automatic fire detection provided?

  Safe

  At Risk

  N/A

• Is there remote transmission of alarm signals?

  Safe

  At Risk

  N/A

• Does the alarm system give both visual and audio signals?

  Safe

  At Risk

  N/A

• Can alarms be heard in all parts of the building including remote areas?

  Safe

  At Risk

  N/A

• Have there been any issues relating to the fire alarm system?<br>(If yes please give details)

  Safe

  At Risk

  N/A

• Have there been any false alarms or hoax calls that have resulted in fire brigade attendance?

  Safe

  At Risk

  N/A

22 Manual fire extinguishing appliances

• Is there suitable and sufficient provision of portable fire extinguishers?

  Safe

  At Risk

  N/A

• Which types of extinguishers are available in the building?

  Select water foam CO2 powder wet chemical blankets

  • water
  • foam
  • CO2
  • powder
  • wet chemical
  • blankets

• Are extinguishers suitably located? <br>(Travel should be less than 30m)

  Safe

  At Risk

  N/A

23 Relevant automatic fire extinguishing systems

• Type of system:

• Comments and observations:

24 Facilities, equipment and devices for the protection of Fire-Fighters

• Types of facilities:

• Comments and observations:

Part 4: MANAGEMENT OF FIRE SAFETY

25 Procedures and arrangements

• Person responsible for fire safety:

• Are there competent persons available to assist in implementing fire safety arrangements?

  Safe

  At Risk

  N/A

• Are appropriate fire procedures in place? (including arrangements for calling the fire service)

  Safe

  At Risk

  N/A

• Fire Policy in place and details recorded?

  Safe

  At Risk

  N/A

• Is the Fire policy up to date and regularly updated?

  Safe

  At Risk

  N/A

• Is the Fire Policy readily available for staff to read?

  Safe

  At Risk

  N/A

• Is the Fire Policy available to the enforcing authority?

  Safe

  At Risk

  N/A

• Are there persons nominated to respond to fire?

  Safe

  At Risk

  N/A

• Are persons nominated to assist with evacuation?

  Safe

  At Risk

  N/A

• Is there appropriate liaison with the fire service?

  Safe

  At Risk

  N/A

• Do routine in-house inspections of fire precautions take place?

  Safe

  At Risk

  N/A

• Are routine fire inspections/fire risk assessments sent to relevant senior managers?

  Safe

  At Risk

  N/A

26 Training and drills

• Are staff given instruction on induction?

  Safe

  At Risk

  N/A

• Is the evacuation of persons at special risk covered by health and safety/fire safety training?

  Safe

  At Risk

  N/A

• Do staff receive periodic refresher training at suitable intervals?

  Safe

  At Risk

  N/A

• Are staff with special responsibilities given appropriate training?

  Safe

  At Risk

  N/A

• Are staff trained in the use of fire extinguishers?

  Safe

  At Risk

  N/A

• Are fire drills carried out at appropriate intervals?

  Safe

  At Risk

  N/A

• Have there been any issues regarding fire safety recorded/noticed during fire drills? (If yes please give details)

• Have staff responsible for fire inspections been suitably trained?

  Safe

  At Risk

  N/A

• Do visitors receive information regarding fire safety when they arrive on site?

  Safe

  At Risk

  N/A

27 Testing and maintenance

• Is there weekly testing and periodic servicing of the fire detection and alarm system?

  Safe

  At Risk

  N/A

• Is there monthly, six-monthly and annual testing of the emergency lighting?

  Safe

  At Risk

  N/A

• Is there annual maintenance and testing of fire extinguishing equipment?

  Safe

  At Risk

  N/A

• Is there annual inspection and test of the lightning protection system?

  Safe

  At Risk

  N/A

• Is there six monthly and annual testing of wet/dry risers?

  Safe

  At Risk

  N/A

• Is there weekly testing and periodic inspection of sprinkler installations?

  Safe

  At Risk

  N/A

• Is there routine checks of fire doors and final exit doors?

  Safe

  At Risk

  N/A

• Other relevant inspection and test

28 Records

• Are there records of fire drills?

  Safe

  At Risk

  N/A

• Are there records of fire training?

  Safe

  At Risk

  N/A

• Are there records of fire alarm tests?

  Safe

  At Risk

  N/A

• Are there records of emergency lighting tests?

  Safe

  At Risk

  N/A

• Are there records of maintenance and testing of other fire protection systems?

  Safe

  At Risk

  N/A

Part 5: RISK RATING AND RECOMMENDATIONS

Risk Items

• Item 1

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 2

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 3

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 4

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 5

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 6

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 7

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 8

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 9

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Item 10

• Add media

  Media

• Probability (likelihood of fire)

  1 = Highly unlikely

  2 = Unlikely

  3 = Possible

  4 = Likely

  5 = Almost certain

• Consequence (impact on life safety)

  1 = Minor injury (No 1st Aid)

  2 = Minor injury (1st Aid)

  3 = Injury (Dr/Hospital treatment)

  4 = Major injury (Disability)

  5 = Fatality

• Risk rating score (probability x consequence)

  Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25

• Recommendations

• Action

• Received by responsible person / representative

  Sign

• Assessor Signature

  Sign

• Pictures

  Media

Re-Assessment

• Recommended date for re-assessment

  Date