Risk Assessment Rating Template

• Conducted on

  Date

• Prepared by

• Location
  Address

General

• Instructions
  ------------------------------
  1. Observe and identify workplace hazards on site which could cause harm to workers. Follow and repeat the steps below for all hazards identified
  2. Click "Add Hazard" to begin documenting risk assessment
  3. Describe hazard and take photo and include annotations where required
  4. Assess the risk rating based on risk matrix reference at bottom of template
  5. Attach any photos, notes or corrective actions by clicking on the paperclip icon
  6. Select the appropriate controls with reference to the hierarchy of controls at bottom of template
  Complete the risk assessment by providing general recommendations and signature
  Generate and export report in PDF, Word or Web Links

• Enter description of procedure, task or worksite being assessed

Hazards, Risks and Controls

• Click Add Hazard (+) after you have observed and identified a hazard

Hazard

Hazard

• Description of hazard

• Photo of hazard (optional)

  Media

Initial risk rating

• Initial consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Initial likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Initial risk rating

  High

  Medium

  Low

Controls

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls PPE Other

  • Elimination
  • Substitution
  • Engineering Controls
  • Administrative Controls
  • PPE
  • Other

• Enter other control measures

Residual risk rating

• Residual consequence

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Residual likelihood

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Residual risk rating

  High

  Medium

  Low

References

• Risk Matrix Reference

  

• Hierarchy of Controls Reference

  

Completion

• Recommendations

• Signature

  Sign