Title Page
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Site conducted
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Activity Assessed
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Issue number
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Purpose of new issue
- general review (2 years since last review)
- Due to an accident
- Due to change in process
- Risk assessment no longer suitable
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Add detailed description of review
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Location
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Assessment Date
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Review Date
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Assessor (name)
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Assisted by (names)
Hazard List
- Add a Hazard
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Select your Hazard
- Contact with electricity
- Contact with moving machinery parts
- Contact with moving object
- Contact with moving vehicles
- Contact with stationary object
- Contact with needle stick or open blade
- Contact with objects at height
- Contact with hazardous materials
- Contact with dusts
- Contact with biohazards
- Lifting objects using mechanical aids
- Lone working
- Moving heavy objects (manually)
- Repetitive movements
- Slippery or uneven surfaces
- Falling from height
- Working at night/ shift work
- Working with display screens
- Working with open flames/ hot work
- Working with deep water
- Working in low/ high temperatures
- Working with loud noises/ long term noise
- Other unlisted hazard
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What is the source of Hazard?
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Who is exposed?
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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What are the existing controls?
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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Use the Risk Matrix to determine the risk rating for this hazard
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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please first go and complete the risk assessment for COSHH/ handling hazardous materials and ensure you have a current safety data sheet available
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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please first complete the risk assessment for Manual handling
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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please first go and complete the risk assessment for using display screen equipment (DSE)
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Other Hazard
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Source of Hazard
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Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
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What is the type of injury that could occur?
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Existing Controls
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How much is the likelihood of occurrence of hazard
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What could be the severity of Injury/ Disease
- Insignificant - Very minor injury, insignificant damage
- Minor - First Aid Injury, minor loss of process, slight damage
- Significant - Lost time injury, loss of process, limited damage
- Major - Reporting Injury, critical loss of process/damage
- Severe - Fatality, catastrophic loss of business
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
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Use the Risk Matrix to determine the risk rating for this hazard
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What is the risk rating for this hazard?
Control Measures and Personal Protective Equipment Required
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Are machinery protection devices (guards, interlocks) used as a control measure for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is there a specific system of work (e.g. SSW, JSA, Work at Height Permit) required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is Hearing Protection required for this task?
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Specify Type/ Grade
- EN352 Disposable ear plugs
- EN352 Reusable ear plugs
- EN352 Over ear defenders
- EN352 Communication Ear defenders
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Task / Hazard Controlled
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Is Eye Protection required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is Respiratory Protection required for this task?
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Specify Type/ Grade
- EN136 - face/dust mask
- EN136 - respirator - face fit required
- self contained breathing apparatus - training required
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Task / Hazard Controlled
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Is Hand Protection required for this task?
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Specify Type/ Grade
- EN388 Puncture resistant
- EN388 Cut resistant
- EN388 Impact resistant
- EN388 Abrasion resistant
- EN374 Chemical resistant
- EN407 Thermal (heat) resistant
- EN511 Thermal (cold) resistant
- EN388 Vibration resistant
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Task / Hazard Controlled
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Is protective coveralls/ clothing required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is Hi Vis Clothing required for this task?
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Specify Type/Grade
- EN471,2 Hi Vis Vest front fastening
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Task / Hazard Controlled
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Is safety footwear required for this task?
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Specify Type/ Grade
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Task / Hazard Controlled
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Is there other personal protective equipment required for this task?
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Please specify
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Specify Type/ Grade
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Task / Hazard Controlled
Sign off
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Manager's Name & Signature
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This document must now be communicated with all relevant persons
