Title Page
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Hazards
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Identify the hazards
Persons Affected
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Decide who might be harmed and how: Staff / Contractors / Public / Clients / Visitors
- Staff
- Contractors
- Public
- Clients
- Visitors
Level of Risk
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Likelihood (of an accident/injury) 1-5
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Severity of Injury/Number of persons affected 1-5
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Enter the Risk Rating by multiplying the likelihood by the severity
Existing Control Measure
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Enter existing control measures
Proposed Control Measures (What else is needed)
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What additional control measures are needed?
Action By
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Name of person responsible
Target Date
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Enter target date
Date Completed
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Enter date completed
Final Risk Rating
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Likelihood (of an accident/injury) 1-5
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Severity of injury/Number of persons affected 1-5
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Enter Risk rating by multiplying the likelihood by the severity
Monitoring
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Enter monitoring method
Review
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Enter date to review Risk Assessment
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Name(s) of Assessor(s)
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Signature(s) of Assessor(s)
