SafetyInsights - Risk Assessment Rating Template

• Conducted on

  Date

• Prepared by

• Location
  Address

• Site

  Select

General

• Instructions
  ------------------------------
  1. Observe and identify workplace risks and hazards on site which could cause harm to workers. Follow and repeat the steps below for all risks and hazards identified
  2. Click "Add Risk/Hazard" to begin documenting risk assessment
  3. Describe risk/hazard. What might go wrong? Who might be harmed and how? Take a photo and include annotations where required
  4. Assess the risk rating based on risk matrix reference at bottom of template. what are you already doing to control the risk?
  5. Attach any photos, notes or corrective actions by clicking on the paperclip icon
  6. Select the appropriate controls with reference to the hierarchy of controls at bottom of template. What else do you need to do to control the risk?
  7. Complete the risk assessment by providing general recommendations and signature

• Enter description of procedure, task or worksite being assessed

Hazards, Risks and Controls

• Click Add Risk/Hazard (+) after you have observed and identified a risk/hazard

Risk/Hazard

• Description of risk/hazard

• Photo of risk/hazard (optional)

  Media

• Initial Risk consequence

  Catastrophic

  Major

  Moderate

  Minor

  Insignificant

• Initial Risk likelihood

  Very Likely

  Likely

  Possible

  Unlikely

  Highly Unlikely

• Initial Risk rating

  Extreme

  High

  Medium

  Low

  Very Low

• Select control measures

  Select Elimination Substitution Engineering Controls Administrative Controls Personal Protective Equipment (PPE) Other

  • Elimination
  • Substitution
  • Engineering Controls
  • Administrative Controls
  • Personal Protective Equipment (PPE)
  • Other

• Enter other control measures

• Residual Risk consequence

  Catastrophic

  Major

  Moderate

  Minor

  Insignificant

• Residual Risk likelihood

  Very Likely

  Likely

  Possible

  Unlikely

  Highly Unlikely

• Residual Risk rating

  Extreme

  High

  Medium

  Low

  Very Low

References

• Risk Matrix Reference

  

• Hierarchy of Controls Reference

  

Completion

• Recommendations

• Signature

  Sign