Risk assessment - duplicate

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by Jim Klein

Risk Identification

• Location or Dept

• Other pertinent information

• Type of issue.

  Select Life Safety Code Compliance Pat Safety General Safety Other

  • Life Safety
  • Code Compliance
  • Pat Safety
  • General Safety
  • Other

• Identification of Risk

• Picture - if possible

  Media

• Under what circumstances would this risk be realized?

• What would the potential consequences of this risk be if realized?

Conclusions

• What is the desired state?

• What is the risk probability?

  Select High Moderate Minimal None

  • High
  • Moderate
  • Minimal
  • None

• What are the consequences?

  Select High Moderate Minimal None

  • High
  • Moderate
  • Minimal
  • None

• Recommendations and actions

• When is the target date for resolution?

  Date

• Estimated / actual cost

• Actual date of resolution

  Date