Risk Assessment Form

• Risk Assessment Form

• Holiday Inn Express - Colchester

• Conducted on

  Date

• Prepared by

• Select date

  Date

• Department

Section 1.

• Outline the location / work activity

Section 2.

• Provide details of the hazards identified

Section 3.

• Who will be affected?

  Select Employee Guest Contractor Visitor

  • Employee
  • Guest
  • Contractor
  • Visitor

Section 4.

• Likelihood of occurrence ?

  Select 1. Remote 2. Unlikely 3. Possibly 4. Likely 5. Certain

  • 1. Remote
  • 2. Unlikely
  • 3. Possibly
  • 4. Likely
  • 5. Certain

• Potential Severity

  Select 1. Insignificant 2. Minor 3. Moderate 4. Major 5. Severe

  • 1. Insignificant
  • 2. Minor
  • 3. Moderate
  • 4. Major
  • 5. Severe

• 

• Current Risk Level = Likelihood x Severity =

Section 5.

• List all existing control measures.

Section 6.

• Are the existing control measures adequate ?

  Yes

  No

  N/A

• Can one or more of the hazards be eliminated ?

  Yes

  No

  N/A

Section 7.

• Identify and list the additional control measures required for safe working.

Section 8.

• Revised likelihood of occurrence

  Select 1. Remote 2. Unlikely 3. Possibly 4. Likely 5. Certain

  • 1. Remote
  • 2. Unlikely
  • 3. Possibly
  • 4. Likely
  • 5. Certain

• Revised Potential Severity

  Select 1. Insignificant 2. Minor 3. Moderate 4. Major 5. Severe

  • 1. Insignificant
  • 2. Minor
  • 3. Moderate
  • 4. Major
  • 5. Severe

• 

• Revised degree of risk - Likelihood x Severity =

Section 9.

• Assessment to be reviewed before:

  Date

• Add signature

  Sign