Risk Assessment

School of Civil & Environmental Engineering

INVENTORY OF WORK ACTIVITIES

Workplace: Form No. Process / Location Date: Work Activities

Risk Assessment

School of Civil & Environmental Engineering

ACTIVITY- BASED RISK ASSESSMENT FORM

Workplace: Conducted by: Process / Location: (Name/ Signature / Date)

Approved by Project Supervisor/ PI: (Name/ Signature / Date)

Last Review Date:

Next Review Date:

1. Hazard Identification
1a. 1b. 1c. 1d. Possible Accident / III Health & Personsat-Risk

2. Risk Evaluation
2a. Existing Risk Control (if any) 2b. 2c. 2d. 3a. Additional Risk Control 3b.

3. Risk Control
3c. 3d. 3e. Follow-up by (name) & date 3f.

No.

Work Activity

Hazard

*S

*L

*R

*S

*L

*R

Remarks

*S Severity, *LLikelihood, *RRisk Level, R=LxS Likelihood : 5 frequent; 4 moderate, 3 occasional, 2 remote, 1 unlikely. Severity : 1 negligible, 2 marginal, 3 serious, 4 very serious, 5 critical Risk Level : 1 5 Low, 6 10 medium, 11 15 warning, 16 and above is considered HIGH

Risk Assessment

School of Civil & Environmental Engineering

Risk Assessment Record

Workplace: Date:

Date

Process / Location

Form No.

Name of Trainee

Trainee Signature

Trainer Signature