Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Threats

Reportable threat

  • Which threat category are you reporting?

  • Choose first the likelihood on a scale of 1-5, then the severity of the consequence from 1-5

    A-standard-risk-matrix.png
  • Likelihood (1-5) 1- rare 2- unlikely 3- possible 4- likely 5- almost certain

  • Consequence (1-5) 1- negligible 2- minor 3- moderate 4- major 5- catastrophic

  • Risk Score

  • This is a negligible risk. Please complete the priority matrix below.

Priority Matrix

  • Do you want to add a priority rating?

  • Choose first the risk score on a scale of 1-5, then the existing controls from 1-5

    Screenshot 2024-06-21 at 14.58.21.png
  • Confirm risk score from above 1- negligible

  • Existing Controls (1-5) 1- strong 2- baseline 3- barely adequate 4- inadequate

  • Priority Score

  • This is a low priority. No need to further report it

    Screenshot 2024-06-21 at 13.49.12.png
  • This constitutes a medium priority. Please attach a corrective action

    Screenshot 2024-06-21 at 13.49.19.png
  • This is a high priority. A notification will be sent to [x person] upon inspection completion. Please provide a corrective action.

    Screenshot 2024-06-21 at 13.49.25.png
  • This is a the highest priority. A notification has been sent to [x person] immediately. Please also provide a corrective action.

    Lab Alert logo.jpg
  • This constitutes a low risk. Please attach a corrective action & complete the probability matrix.

    Screenshot 2024-06-21 at 11.40.09.png

Priority Matrix

  • Do you want to add a priority rating?

  • Choose first the risk score on a scale of 1-5, then the existing controls from 1-5

    Screenshot 2024-06-21 at 14.58.21.png
  • Confirm risk score from above 2- low

  • Existing Controls (1-4) 1- strong 2- baseline 3- barely adequate 4- inadequate

  • Priority Score

  • This is a low priority. No need to further report it

    Screenshot 2024-06-21 at 13.49.12.png
  • This constitutes a medium priority. Please attach a corrective action

    Screenshot 2024-06-21 at 13.49.19.png
  • This is a high priority. A notification will be sent to [x person] upon inspection completion. Please provide a corrective action.

    Screenshot 2024-06-21 at 13.49.25.png
  • This is a the highest priority. A notification has been sent to [x person] immediately. Please also provide a corrective action.

    Lab Alert logo.jpg
  • This is a moderate level risk. A notification will be sent to [x person] upon inspection completion. Please attach a corrective action & complete the probability matrix.

    Screenshot 2024-06-21 at 11.40.19.png

Priority Matrix

  • Do you want to add a priority rating?

  • Choose first the risk score on a scale of 1-5, then the existing controls from 1-5

    Screenshot 2024-06-21 at 14.58.21.png
  • Confirm risk score from above 3- moderate

  • Existing Controls (1-5) 1- strong 2- baseline 3- barely adequate 4- inadequate

  • Priority Score

  • This is a low priority. No need to further report it

    Screenshot 2024-06-21 at 13.49.12.png
  • This constitutes a medium priority. Please attach a corrective action

    Screenshot 2024-06-21 at 13.49.19.png
  • This is a high priority. A notification will be sent to [x person] upon inspection completion. Please provide a corrective action.

    Screenshot 2024-06-21 at 13.49.25.png
  • This is a the highest priority. A notification has been sent to [x person] immediately. Please also provide a corrective action.

    Lab Alert logo.jpg
  • This is a high level risk. A notification has been sent to [x person] immediately. Please also attach a corrective action & complete the probability matrix.

    Screenshot 2024-06-21 at 11.40.26.png

Priority Matrix

  • Do you want to add a priority rating?

  • Choose first the risk score on a scale of 1-5, then the existing controls from 1-5

    Screenshot 2024-06-21 at 14.58.21.png
  • Confirm risk score from above 4- high

  • Existing Controls (1-4) 1- strong 2- baseline 3- barely adequate 4- inadequate

  • Priority Score

  • This is a low priority. No need to further report it

    Screenshot 2024-06-21 at 13.49.12.png
  • This constitutes a medium priority. Please attach a corrective action

    Screenshot 2024-06-21 at 13.49.19.png
  • This is a high priority. A notification will be sent to [x person] upon inspection completion. Please provide a corrective action.

    Screenshot 2024-06-21 at 13.49.25.png
  • This is a the highest priority. A notification has been sent to [x person] immediately. Please also provide a corrective action.

    Lab Alert logo.jpg
  • This is a severe level risk. A notification has been sent to [x person] immediately. Please also attach a corrective action & complete the probability matrix.

    Lab Alert logo.jpg

Priority Matrix

  • Do you want to add a priority rating?

  • Choose first the risk score on a scale of 1-5, then the existing controls from 1-5

    Screenshot 2024-06-21 at 14.58.21.png
  • Confirm risk score from above 5- severe/critical

  • Existing Controls (1-4) 1- strong 2- baseline 3- barely adequate 4- inadequate

  • Priority Score

  • This is a low priority. No need to further report it

    Screenshot 2024-06-21 at 13.49.12.png
  • This constitutes a medium priority. Please attach a corrective action

    Screenshot 2024-06-21 at 13.49.19.png
  • This is a high priority. A notification will be sent to [x person] upon inspection completion. Please provide a corrective action.

    Screenshot 2024-06-21 at 13.49.25.png
  • This is a the highest priority. A notification has been sent to [x person] immediately. Please also provide a corrective action.

    Lab Alert logo.jpg

Final Scores & Signature

Final risk & priority rating

  • This repetition is important for data analysis purposes.

  • Final Risk Rating

  • Final Priority Rating

  • 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.