Title Page

  • Conducted on

  • Prepared by

  • Location


  • Description of procedure, task or worksite being assessed

Risk Matrix and Hierarchy of Controls

  • Risk Matrix Reference:

  • Hierarchy of Controls Reference:


Hazard Register

  • Description of hazard

  • Photo of hazard

Risk Rating

  • Consequences

  • Likelihood

  • Risk Rating (refer risk matrix above)

  • Comments/ observations


  • Select control measures

  • Enter other

  • Explanation of controls


  • Recommendations

  • Signature

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.