Risk Assessment

• Where is work to be completed ?

• Location
  Address

• Image

  Media

• Description of work to be completed

• Conducted on

  Date

• Prepared by

• Document number

Hazard, Risks and Controls

• What is the hazard?

  Select Slip Trips on Level Slip Trips at Height Falls From Height Manual Handling DSE associated Hazards Cuts and Abrasion Hazardous Chemicals Burns or Scalds Lone Working Fire Electrical Exposure to Cold/ Heat Noise Dust Fume Asbestos Weils Disease Lead Confined Space Entrapment Entanglement Contact with moving parts Ejection of parts or materials Other - Define in the 'How May Harm Materialise box below)

  • Slip Trips on Level
  • Slip Trips at Height
  • Falls From Height
  • Manual Handling
  • DSE associated Hazards
  • Cuts and Abrasion
  • Hazardous Chemicals
  • Burns or Scalds
  • Lone Working
  • Fire
  • Electrical
  • Exposure to Cold/ Heat
  • Noise
  • Dust
  • Fume
  • Asbestos
  • Weils Disease
  • Lead
  • Confined Space
  • Entrapment
  • Entanglement
  • Contact with moving parts
  • Ejection of parts or materials
  • Other - Define in the 'How May Harm Materialise box below)

• How may the Hazard cause Harm

• Who Might be Harmed

  Select Employees Other Contractors Customer Employees Members of the Public Children Vulnerable Adults New and Expectant Mothers

  • Employees
  • Other Contractors
  • Customer Employees
  • Members of the Public
  • Children
  • Vulnerable Adults
  • New and Expectant Mothers

• What are the current control measures?

• What is the likelihood of Harm being caused?

  Very Likely

  Likely

  Unlikely

  Highly Unlikely

• What are the consequences or Severity of the Harm?

  Fatality

  Major Injuries

  Minor Injuries

  Negligible Injuries

• What is the risk level?

  High

  Medium

  Low

• Is the risk level acceptable?

  Yes

  No

  N/A

• Yes

  No

  N/A

Completion

• Signature

  Sign
Staff Sign Off

• Name

• Signature

  Sign

• Date

  Date