RISK ASSESSMENT RECORDING FORM

Location or
Address: p1:9
Activity or
Situation
(1)

Hazard

Date Assessment
Undertaken:
Review
Date:
Risk

(2) Who might be harmed and how?

A1B3 Member of the crew getting their

foot stuck and tripping.

Assessment undertaken
By:
Signature

(3) What controls exist to reduce

risk

(4) What action can be taken

to further reduce risk?

Move the tables out of the way of

tripping zone.

Tables
Chairs

Wires

A1b3

Tuck chairs under the desk when

theyre not in use and ensure
everyone sits on them properly.

A1b3

A1b4
Bags

Member of the crew leaning too far

and falling off the chair or tripping
over the chair legs.
Members of the crew, not looking
where theyre going and tripping
over ways laying on the floor.

Put covers on the wires so that

people cannot trip over them.

Tuck the wires under the table to

decrease risk.

Members of the crew could get their

foot caught in bag straps and fall or
trip over the bag.

Keep bags lifted up off the floor to

avoid any injuries.

Ensure bags are tucked tightly

under the table to make sure no
one has a chance off falling.

1. List hazards something with the potential to cause harm here:

Seek to quantify the level of risk the likelihood of harm arising based on the number of persons affected, how often they are exposed to the hazard and the
severity of any consequence.
2. List groups of people who are especially at risk from the significant hazards which you have identified
3. List existing controls here or note where the information may be found
4. List the risks which are not adequately controlled and the action you will take. Have regard for the level of risk, the cost of any action and the benefit you expect to
gain.

(1)

Hazard

Risk

(2) Who might be harmed and how?

(3) What controls exist to reduce

risk

(5) What action can be taken

to further reduce risk?

RISK RATING
a SEVERITY

b LIKELIHOOD

c FINAL SCORE RATING: what needs to be done

Dying or being permanently disabled

Will almost certainly happen

Serious injury/long term illness

Highly likely to happen

Temporary disability/3 days off sick

Not so likely

Will need medical attention

Even less likely

Minor injury eg. Bruise, graze

Unlikely to happen at all

16-25 Stop! Do not start activity again until risk is

controlled
10-15 High risk level, High priority. Take action
straight away to control the risk
6-9
Medium risk level. Tighten up controls and
make a plan to do something about risk
3-5
Fairly low risk level. Low priority but keep
possible action in mind
1-2
Low or trivial risk. No further action
required.

SO: a x b = c
Action Required

Responsible Person

Date for Completion