Title Page

  • Conducted on

  • Enter site name

  • Prepared by

  • Location

General

  • Enter description of procedure, task or worksite being assessed

Hazards, Risks and Controls

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

  • Hazard

Hazard

  • Activity

  • Description of hazards identified

  • Photo of hazard (optional)

  • Persons at risk

Initial risk rating

  • Initial consequence

  • Initial likelihood

  • Initial risk rating

Controls

  • Select control measures

  • Enter other control measures

  • Enter description of control measures

Residual risk rating

  • Residual consequence

  • Residual likelihood

  • Residual risk rating

References

  • Risk Matrix Reference

    Screen Shot 2018-05-21 at 11.14.28 am.png
  • Hierarchy of Controls Reference

    OSH toolkit noise - hierachy of controls.jpg

Completion & Work Group Sign Off

  • Recommendations

  • Signature

  • Signature

  • Signature

  • Signature

  • Signature

  • Signature

  • 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.