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Risk Assessment Form Template

The document is a risk assessment form that contains sections for describing a task, identifying hazards, evaluating risk levels, planning actions, and signing off on the assessment. It includes tables for listing hazards, rating risks, and required further actions.

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rychdbokor112
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63 views3 pages

Risk Assessment Form Template

The document is a risk assessment form that contains sections for describing a task, identifying hazards, evaluating risk levels, planning actions, and signing off on the assessment. It includes tables for listing hazards, rating risks, and required further actions.

Uploaded by

rychdbokor112
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Risk Assessment Form

Project Name: .....................................................................................................................

Project Location: ................................................................................................................

Assessment Date: ................................................................................................................

Assessor's Name: ................................................................................................................

Job Title: .............................................................................................................................

Section 1: Task/Activity Description

Task/Activity: Describe the specific task or activity being assessed

Location of Task/Activity: Specify the exact location within the project site

Duration of Task/Activity: Estimate the duration for the task/activity

Section 2: Hazard Identification

No. Hazard Potential Harm Persons at Risk Existing Control Measures


1
2
3

1
FORM ID: RAF-01/24
Section 3: Risk Evaluation

Risk Matrix:

Likelihood (L) Severity (S) Risk Rating (L x S)


1 = Rare 1 = Minor injury Low (1-3)
2 = Unlikely 2 = Moderate Medium (4-6)
3 = Possible 3 = Serious High (7-9)
4 = Likely 4 = Major injury Very High (10-12)
5 = Almost certain 5 = Fatality Critical (15-25)

Risk Assessment Table:

No Hazard Likelihood Severity Risk Rating Risk Further


. (L) (S) (L x S) Level Actions
Required
1

2
FORM ID: RAF-01/24
Section 4: Action Plan

Further Actions Required:

No Hazard Action Responsible Target Completion


. Required Person Date Date
1

Section 5: Review and Sign-Off

Assessor's Signature: ________________________


Date:

Reviewed By: ________________________


Date:

Project Manager's Approval: ________________________


Date:

Next Review Date: ............................................................................

3
FORM ID: RAF-01/24

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