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

1

0

0

2

0

0

3

0

0

4

0

0

5

0

0

6

0

0

7

0

0

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 8 0 0 9 0 0 10 0 0 11 0 0 12 0 0 13 0 0 14 0 0 .

Reduce risk ASAP. If it does proceed ensure there is constant careful supervision. Try to reduce risk further Caution.Likelihood 1 2 3 4 5 Consequence 1 2 3 4 5 Risk 1-4 5-9 10-16 Outcome Acceptable. but it is not recommended that the activity proceeds. Adequate. This level of risk is not allowed. Fatalities. Complete Disability Assets (U$) <10’000 <100’000 <1’000’000 <10’000’000 >10’000’000 Guideword Very Unlikely Unlikely Fairly Likely Likely Very Likely 17-25 . It is allowed. Ensure emergency equipment is available. Amputations Fatality. Ensure controls are properly maintained. Unacceptable. Stop Immediately Guideword Insignificant Minor Moderate Major Massive People No Injury First Aid Cases Broken Bones Partial Disability.

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