Logo COVID-19 RISK ASSESSMENT TEMPLATE

Exposure
Job type Workers in this category include:
Risk
4 High potential for exposure to known or suspected
Very High sources of COVID-19 during specific medical, post
mortem, or laboratory procedures.

3 High potential for exposure to known or suspected

High sources of COVID-19.

2 Frequent &/or close contact with (i.e. within 2 meters

Medium of) people who may be infected with the virus, but who
are not known or suspected COVID-19 patients.

1 Do not require contact with people known to be, or

Low suspected of being infected with the virus, nor frequent
close contact with (i.e. within 2 meters of) the general 5 (L)
public.
 Logo COVID-19 RISK ASSESSMENT TEMPLATE
Premises Department
Work Area
Date of Risk Assessment
CURRENTS SUGGESTED RISK CONTROL
RISK MEASURES
CONTROL c ) use engineering controls;
IDENTIFIED Exposure MEASURES d) use admin controls, incl training;
NO WHAT ARE THE RISKS Job type LOSS TYPE
HAZARDS Risk (How are you e) use adequate PPE
currently
controlling the
risk?)
Human exopsure to virus. Illness/
1 HBA COVID-19 General cleaners 2 Gloves, masks Health, Prodution Loss
disease

10

11

12

Doc No: / Rev: 14 April 2020

© This document contains confidential and proprietary information. / This information is private and any disclosure, copying or distribution of, or taking any unauthorized action based on this document is prohibited.
 Logo COVID-19 RISK ASSESSMENT TEMPLATE
NOT SOP TO BE
DETAILS OF ADDITIONAL RISK CONTROLS ACCEPTA- PRIORITY OF RESPONSIBLE COMPLETION SIGNATU
NO ACCEPTA- DEVELOPED? TARGET DATE
NEEDED/ RESIDUAL RISK BLE RISK THE RISK PERSON(S) DATE RE
BLE RISK (Yes or No)

10

Additional Comments

Risk assessment Risk assessment trained person:

Date Siignature
prepared by
a) Date Siignature

b) Date Siignature
Other participant names:
c) Date Siignature

Date Siignature
Consultation Staff consultation SHE Rep:
Position
Check / Validation Checked / Validated by:
Date Siignature
Doc No: / Rev: 14 April 2020

© This document contains confidential and proprietary information. / This information is private and any disclosure, copying or distribution of, or taking any unauthorized action based on this document is prohibited.