Title Page

  • Location of the Workplace

  • Prepared on

  • Prepared by

Focus of the Workplace Risk Assessment

Goal of the Workplace Risk Assessment

  • Why is this workplace risk assessment needed? (Other than being legally required)

  • How could this workplace risk assessment help your business and your employees?

  • What is the intended result, effect, or output of this workplace risk assessment?

Scope of the Workplace Risk Assessment

  • What's included in this workplace risk assessment?

  • What's not included in this workplace risk assessment?

Important Details Regarding the Workplace Risk Assessment

  • Who will be involved in this workplace risk assessment and what level of responsibility or participation do they have?

  • Where (specific room, site, facility, building, or area) will this workplace risk assessment be performed?

  • Other: please specify

  • When will this workplace risk assessment be performed?

Workplace Risk Assessment

  • To begin the workplace risk assessment, select the "+" icon next to Hazard:

  • Hazard
  • Description of hazard

  • Photo of the hazard (optional)

  • Activity associated with this hazard in this area

  • Risk related to hazard

  • Please specify

  • Who might be harmed?

  • Please specify

  • Risk likelihood

  • Risk consequences

  • Use this risk matrix to identify the risk level:

    Risk Matrix SafetyCulture.png
  • Hierarchy of control.

    413px-NIOSH’s_“Hierarchy_of_Controls_infographic”_as_SVG.svg.png
  • Risk level

  • Hazard causing risk can be eliminated?

  • Are you already doing something to control this risk to as low as reasonable practicable (ALARP)?

  • Apply control measures

  • What PPE is required?

  • Please specify what type of eye protection

  • Please specify what type of gloves

  • Please specify other control measure

  • When will control measures be implemented?

  • When will this be done by?

  • And by whom? Create an action

  • How will you monitor the effectiveness of these risk control measures?

  • Please specify

  • What is the residual risk rating now after all steps taken to ensure risk is as low as reasonably practicable (ALARP)?

  • Move onto next hazard.

  • Please specify what other services are isolate

  • What existing control measures are in place?

  • If answered Other, please specify

  • What PPE is required?

  • Please specify what type of eye protection

  • Please specify what type of gloves

  • Please specify what other services are to be isolated

  • Is any further action needed to control the risk to as low as reasonably practicable (ALARP)?

  • Please type in what other control measures are required:

  • When will control measures be implemented?

  • When will this be done by?

  • And by whom? Create an action

  • How will you monitor the effectiveness of these risk control measures?

  • Please specify

  • What is the residual risk rating now after all steps taken to ensure risk is as low as reasonably practicable (ALARP)?

  • Move onto next hazard in this area.

  • How will you monitor the effectiveness of these risk control measures?

  • If other, please specify

  • What is the residual risk rating now after all steps taken to ensure risk is as low as reasonably practicable (ALARP)?

  • Move onto next hazard in this area.

  • When will control measures be implemented?

  • When will this be done by?

  • And by whom? Create an action.

  • How will you monitor the effectiveness of these risk control measures?

  • Please specify

  • How will you monitor the effectiveness of these risk control measures?

  • If other, please specify

  • What is the residual risk rating now after all steps taken to ensure risk is as low as reasonably practicable (ALARP)?

  • Move onto next hazard in this area.

  • Eliminate the hazard causing the risk. Move onto the next hazard.

  • 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

  • How often will you review this workplace risk assessment?

  • The HSE recommends reviewing workplace risk assessments at least annually.

  • Name and Signature of Employer/Owner/Manager of Workplace

  • Did the employer/owner/manager of the workplace perform the workplace risk assessment himself/herself?

  • Name and Signature of Appointed Person

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.