A risk assessment form is a form filled to review or evaluate the possibility of a risk happening. A risk assessment form is filled mainly in insurance companies where people protect themselves against specific risks. This form is also filled in institutions and places of work. Below is an example of a risk assessment form.
Personal Details
First name Middle name Last name
____________ _____________ _____________
Age
______
Contact Information
Address
_______________________________
_______________________________
Telephone
Home __________________ Mobile _______________
__________________________
Fax
________________________
Health Information
Are you handicapped?
Yes ______ No ______
List any terminal disease that you suffer/have suffered from?
___________________________
Have you undergone any major surgeries in the past three years?
___________________________
What is your source of income?
I am employed ___________ I am in business _________
Give contact information for your business/employer.
Name _________________________
Address __________________________
Telephone __________________________
Bank Information
Type of account __________________
Name of bank _____________
Account no. _____________
__________________ ____________________
Signature Date
Print This Post