Description of hazard

  • Type of hazard

  • Explain the hazard & the context in how the hazard poses a risk

  • Add photo of hazard

Assess the risk

  • What would a reasonably foreseeable outcome be if an incident occurred

  • Consequence

  • Likelihood

  • Risk Rating

Control the hazard

  • Describe what you have done to make the hazard safe!

  • Take a picture of your completed actions

Long term recommendations

  • Do you recommend any long term solutions or do you have any additional comments

Person raising hazard sign off

  • Please sign

Supervisor, Safety Advisor or Manager comments

  • What follow up action is required in your opinion

  • Do you recommend that a formal risk assessment be conducted

  • Add signature

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