YourCompanyHere RISK ASSESSMENT FORM

Activity, Equipment or Location being risk assessed: Location: Date:

Expected Consequence Current Risk Current Controls
Likely Consq Risk

Carried out by: Review Date:

Current Recovery Extra Controls or Recovery Measures Needed? Measures New risk
Likely Consq Risk

Hazard Identified

Action Party

Target Date

YourCompanyHere RISK ASSESSMENT FORM

Activity, Equipment or Location being risk assessed: Location: Date:
Expected Consequence Current Risk Current Controls
Likely Consq Risk

Carried out by: Review Date:

Current Recovery Extra Controls or Recovery Measures Needed? Measures New risk
Likely Consq Risk

Hazard Identified

Action Party

Target Date

10

11

12

13

14

Likelihood 1 2 3 4 5 Consequence 1 2 3 4 5 Risk 1-4 5-9 10-16 Outcome Acceptable. Ensure controls are properly maintained. Adequate. Try to reduce risk further Caution. It is allowed, but it is not recommended that the activity proceeds. If it does proceed ensure there is constant careful supervision. Ensure emergency equipment is available. Reduce risk ASAP. Unacceptable. This level of risk is not allowed. Stop Immediately Guideword Insignificant Minor Moderate Major Massive People No Injury First Aid Cases Broken Bones Partial Disability, Amputations Fatality, Fatalities, Complete Disability Assets (U$) <10000 <100000 <1000000 <10000000 >10000000 Guideword Very Unlikely Unlikely Fairly Likely Likely Very Likely

17-25