Title Page
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Location of the Workplace
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Prepared on
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Prepared by
Focus of the Risk Assessment
Goal & scope of the Risk Assessment
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What is the intended result, effect, or output of this risk assessment?
Important Details Regarding the Workplace Risk Assessment
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Who will be involved in this workplace risk assessment and what level of responsibility or participation do they have?
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Where (specific room, site, facility, building, or area) will this workplace risk assessment be performed?
Risk Assessment
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Use this risk matrix to identify the risk level:
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To begin the workplace risk assessment, select the "+" icon next to Hazard:
Hazard
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Description of hazard
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Photo of the hazard (optional)
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Who might be harmed?
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Risks related to hazard (How could they be harmed)
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Current Controls
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Likelihood
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Consequences
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Current Risk rating
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Additional Required Actions
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Required by
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Person(s) responsible for implementation
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No further action required at this time. Management to continue monitoring.
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Likelihood after additional controls have been implemented
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Consequences after additional controls have been implemented
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Residual Risk rating
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To ADD another hazard to the workplace risk assessment, select the "+" icon next to Hazard.
To END the workplace risk assessment, select the "Next Page >" button at the bottom right.
Completion/Review
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How often will this risk assessment be reviewed?
- Every 2 weeks
- Every month
- Every 3 months
- Every 6 months
- Every year
- Every 15 months
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The HSE recommends reviewing workplace risk assessments at least annually.
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Name and Signature of Employer/Owner/Manager of Workplace
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Did the employer/owner/manager of the workplace perform the workplace risk assessment himself/herself?
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Name and Signature of Appointed Person
