A blank risk assessment form is an assessment form used to review risks. A blank risk assessment form like the name suggests is not specific. It is used to determine the probability of a risk happening. It is mostly used by insurance companies for their customers when they want to take insurance covers.
Personal Information
Last name Middle name First name
____________ _________________ _______________
Date of birth ______________
Telephone: Home ______________ Office _____________
Address _______________
Email __________
Employment status ____________
Marital status ______________
Do you have any children?
_____________
Who is your next of kin?
__________________
Relationship __________
Kindly list your assets
___________________________________________________
Health
Do you have any physical disabilities?
___________
Do you use hearing aids or contact lenses?
___________
List any illnesses that you think you might have.
_________________________________________________________________
Have you ever had any major surgeries?If Yes, please explain:
_________________
Have you ever been dependent on drugs or alcohol?
_______________
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