Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Hazards

  • Identify the hazards

Persons Affected

  • Decide who might be harmed and how: Staff / Contractors / Public / Clients / Visitors

Level of Risk

  • Likelihood (of an accident/injury) 1-5

  • Severity of Injury/Number of persons affected 1-5

  • Risk Matrix
  • Enter the Risk Rating by multiplying the likelihood by the severity

Existing Control Measure

  • Enter existing control measures

Proposed Control Measures (What else is needed)

  • What additional control measures are needed?

Action By

  • Name of person responsible

Target Date

  • Enter target date

Date Completed

  • Enter date completed

Final Risk Rating

  • Likelihood (of an accident/injury) 1-5

  • Severity of injury/Number of persons affected 1-5

  • Enter Risk rating by multiplying the likelihood by the severity

Monitoring

  • Enter monitoring method

Review

  • Enter date to review Risk Assessment

  • Name(s) of Assessor(s)

  • Signature(s) of Assessor(s)

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.