Task-Based risk assessment

Title Page

Site conducted
Location
Activity Assessed
Add a detailed description of activity via notes or add as media (video or .pdf)
Version number
Purpose of new version
- general review (2 years since last review)
- Due to an accident
- Due to change in process
- Risk assessment no longer suitable
Add detailed description of review
Assessment Date
Review Date
Assessor (name)
Assisted by (names)

Hazard List

Select your Hazard
- Contact with electricity (more than mains voltage)
- Contact with static 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 radiation
- Contact with biohazards
- Contact with pressurised systems
- 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 open flames/ hot work
- Working with deep water
- Working in low/ high temperatures
- Working with loud noises/ long term noise
- Other unlisted hazard
What is the source of Hazard?
Who is exposed?
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
What is the type of injury that could occur?
What are the existing controls?
What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
What would be the impact of the injury/ disease/ damage? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
Risk number is:
The risk rating for this hazard is Very Low
The overall Risk Rating for this hazard is Low
The overall risk rating for this hazard is Medium
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
The risk rating for this hazard is High - consider an action to reduce the risk level
The risk rating for this hazard is Very High
The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
Use the Risk Matrix to determine the risk rating for this hazard
please first go and complete the risk assessment for COSHH/ handling hazardous materials and ensure you have a current safety data sheet available
Source of Hazard
Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
What is the type of injury that could occur?
Existing Controls
What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
What would the impact of the injury/ disease/ damage be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
Risk number is:
The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
The risk rating for this hazard is Very Low
The risk rating for this hazard is Low
The overall risk rating for this hazard is Medium
The risk rating for this hazard is High - consider an action to reduce the risk level
The risk rating for this hazard is Very High
Use the Risk Matrix to determine the risk rating for this hazard
please first complete the risk assessment for Manual handling
Source of Hazard
Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
What is the type of injury that could occur?
Existing Controls
What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
What would the impact of the injury/ disease/ damage be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
Risk number is:
The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
The risk rating for this hazard is Very Low
The risk rating for this hazard is Low
The overall risk rating for this hazard is Medium
The risk rating for this hazard is High - consider an action to reduce the risk level
The risk rating for this hazard is Very High
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
- 20-25 Extreme
- 15-19 Very High
- 10-14 High
- 5-9 Medium
- 3-4 Low
- 1-2 Very Low
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
Other Hazard
Source of Hazard
Who is exposed
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
What is the type of injury that could occur?
Existing Controls
What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
What would the impact of the injury/disease/ damage be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
Risk number is:
The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
The risk rating for this hazard is Very Low
The risk rating for this hazard is Very Low
The overall risk rating for this hazard is Medium
The risk rating for this hazard is High - consider an action to reduce the risk level
The risk rating for this hazard is Very High
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
- 20-25 Extreme
- 15-19 Very High
- 10-14 High
- 5-9 Medium
- 3-4 Low
- 1-2 Very Low
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
What is the radiation type?
What is the source of Hazard?
Who is exposed?
- Employee
- Colleague
- Third Party employee (or contractor)
- Visitor
- Member of Public
- Young person
- New or expectant mother
What is the type of injury that could occur?
What are the existing controls?
What is the likelihood of an incident occurring? (1= rare, 2 = unlikely, 3 = moderate, 4 = likely, 5 = almost certain)
What would the impact of the injury/disease be? (1= insignificant, 2 = minor, 3 = moderate, 4 = significant, 5 = severe)
Risk number is:
The risk rating for this hazard is Extreme and the task should not progress until this hazard has been mitigated
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure
The risk rating for this hazard is Very Low
The risk rating for this hazard is Low
The overall risk rating for this hazard is Medium
The risk rating for this hazard is High - consider an action to reduce the risk level
The risk rating for this hazard is Very High
Use the Risk Matrix to determine the risk rating for this hazard
What is the risk rating for this hazard?
- 20-25 Extreme
- 15-19 Very High
- 10-14 High
- 5-9 Medium
- 3-4 Low
- 1-2 Very Low
An action should be raised to reduce the risk rating for this hazard by implementing an improved control measure

Control Measures and Personal Protective Equipment Required

Are machinery protection devices (guards, interlocks) used as a control measure for this task?
Specify Type/ Grade
Task / Hazard Controlled
Is there a specific system of work (e.g. SSW, JSA, Work at Height Permit) required for this task?
Specify Type/ Grade
Task / Hazard Controlled
Is Hearing Protection required for this task?
Specify Type/ Grade
- EN352 Disposable ear plugs
- EN352 Reusable ear plugs
- EN352 Over ear defenders
- EN352 Communication Ear defenders
Task / Hazard Controlled
Is Eye Protection required for this task?
Specify Type/ Grade
Task / Hazard Controlled
Is Respiratory Protection required for this task?
Specify Type/ Grade
- EN136 - face/dust mask
- EN136 - respirator - face fit required
- self contained breathing apparatus - training required
Task / Hazard Controlled
Is Hand Protection required for this task?
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
Task / Hazard Controlled
Is protective coveralls/ clothing required for this task?
Specify Type/ Grade
Task / Hazard Controlled
Is Hi Vis Clothing required for this task?
Specify Type/Grade
- EN471,2 Hi Vis Vest front fastening
Task / Hazard Controlled
Is safety footwear required for this task?
Specify Type/ Grade
Task / Hazard Controlled
Is there other personal protective equipment required for this task?
Please specify
Specify Type/ Grade
Task / Hazard Controlled