HSE Risk Assessment Form

Site Department Core Activity Description

No. at risk Location
✘
RA Ref Number New
Assessed By
Date Completed Rev
Approved By Date Approved Rev#
Risk/significance evaluation
Risk/significance evaluation

Int parties Y/N

Legal & other

Risk Rating

Risk Rating
Likelihood

Likelihood
Risk/Sig

Risk/Sig
Severity

Severity
req.Y/N
Hazards / Additional controls

Level

Level
Tasks / sub- Impact to people / Existing control By By
environment required to reduce risk Remarks
activities environment measures Whom When
aspects / significance

0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low
0 Low 0 Low