Title Page

  • Conducted on

  • Prepared by

  • Location

Overview

  • Description of procedure, task or worksite being assessed

Risk Matrix and Hierarchy of Controls

  • Risk Matrix Reference:

    risk_matrix.png
  • Hierarchy of Controls Reference:

    controls.png

Hazard Register

    Hazard
  • Description of hazard

  • Photo of hazard

Risk Rating

  • Consequences

  • Likelihood

  • Risk Rating (refer risk matrix above)

  • Comments/ observations

Controls

  • Select control measures

  • Enter other

  • Explanation of controls

Completion

  • Recommendations

  • Signature

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