Risk assessment [Sample template]

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  Everything you see in this sample inspection experience can be customized using the Template Editor.
  
  This page is the title page, which is the first page you see when you conduct a new inspection or view an inspection report.
  
  Title pages are a great way to capture essential details, giving you high-level context to inspection results.

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

Work activity

• Advise the work activity that appears to be a risk

• Enter details of activity

Identified hazards

• How many hazards identified in relation to the particular activity

• Take picture of hazard if possible

  Media

Who might be harmed?

• Who can be harmed or affected by these risks?

  Staff

  Client/Visitors

  Everyone

Description

• Advise description of risks

Risk rating

• Severity

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• Probability of occurance

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• Risk rating

  High

  Medium

  Low

• Reference: Risk Matrix

Resolution

• Indicate if this risk can be controlled immediately or not

  Select Requires Additional attention / control Adequately Controlled Unknown Risk

  • Requires Additional attention / control
  • Adequately Controlled
  • Unknown Risk

Implement plan

• Enter description of implementation plan

• List who will be responsible for actioning the implementation plan

• When will this be actioned and completed by?

  Date

Completion

• Risk assessment has been completed

  Yes

  No

  N/A

• Risks reported have been resolved and completed

  Yes

  No

  N/A

• Signature

  Sign

• Yes

  No

  N/A