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Information
Date of Take 5
Client / Site
Conducted on
Prepared by
ALL SECTIONS COMPLETE
Please select you’re assessment score from 1 – 5.
1 being “Not all sections completed” to
5 being “All sections completed”
INFORMATION MISSING
Please select you’re assessment score from 1 – 5.
1 being “Information missing (e.g. name, date)” to
5 being “No information missing”
NO HAZARDS IDENTIFIED
Please select you’re assessment score from 1 – 5.
1 being “No hazards identified” to
5 being “All applicable hazards identified”
NO CONTROLS IDENTIFIED
Please select you’re assessment score from 1 – 5.
1 being “No controls identified” to
5 being “All applicable controls identified”
HAZARDS APPROPIATE TO THE TASK
Please select you’re assessment score from 1 – 5.
1 being “Hazards aren’t appropriate to the task” to
5 being “All hazards are appropriate to the task”
IDENTIFIED CRITICAL HAZARDS
Please select you’re assessment score from 1 – 5.
1 being “Failed to identify critical hazards” to
5 being “Identified all critical hazards for the task”
CONTROLS NOT APPROPRIATE FOR THE RISK
Please select you’re assessment score from 1 – 5.
1 being “Controls aren’t appropriate for the risk” to
5 being “Controls adequately reduce the risk”
RISK SCORE NOT COMPLETED
Please select you’re assessment score from 1 – 5.
1 being “Risk score not completed” to
5 being “Risk scores completed properly e.g. “L4”
RISK SCORE DOES NOT CHANGE FOR DIFFERENT HAZARDS
Please select you’re assessment score from 1 – 5.
1 being “Risk score does not change for different hazards” to
5 being “Risk scores fluctuate appropriately according to the controls in place”
PERSONNEL UNDERSTANDS TBRA
Please select you’re assessment score from 1 – 5.
1 being “DOES NOT UNDERSTAND AND REQUIRES TRAINING'
5 being “UNDERSTANDS WELL NO TRAINING REQUIRED'
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The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice.
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You should independently determine whether the template is suitable for your circumstances.
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