Risk assessment forms are used by companies and organizations of all sizes to determine their levels of safety. It is also used to find any lapses that may be hazardous to the safety of people working or staying at the premises. A blank risk assessment is filled periodically in order to update safety details and determine any necessary steps to take in order to lower or to do away with risks.

Risk Assessment Form

Assessment reference Number: ___________________ Date of assessment: ___________

Assessed by (Name): ___________________________ Location: ____________________

Checked / Validated by: _________________________ Review Date: _________________

Task / premises: ___________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

1. Activity

Site Assessed: ________________ Hazard: ______________________________________

Who might be harmed and how________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Existing risk control measures: ________________________________________________

__________________________________________________________________________________________________________________________________________________

Risk rating: _______________________________________________________________

Assessment Results: ________________________________________________________

Results Key:

1 = Trivial    3 = not adequately controlled requires attention

2 = adequately controlled 4 = risk unknown

2. Action Plan

Reference Number: __________________

Further action required: ______________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Action to be taken by: __________________________ Deadline: ____________________

Notes: ___________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Assessed by (Signature): ______________________ Date: _____________________

Checked by: (Signature): ______________________ Date: _____________________

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