Compliance Risk assessment Form
GENERAL INFORMATION
Department/Unit:
Assessment Date:
Assessor Name/Title:
Contact Information:
Reviewed by:
Review date:
Risk Identification
Risk Regulatory Potential Likelihood Existing
Risk Category
Description Reference Impact Occurrence Controls
[ ] Financial [ ] High [ ] Rare
[ ] Operational [ ] Medium [ ] Unlikely
[ ] Reputational [ ] Low [ ] Possible
[ ] Legal [ ] Likely
[ ] Strategic [ ] Almost certain
Risk Evaluation
Impact Level
Likelihood Risk Score Risk Rating
(High, Overall Risk Evaluation
Level (High, (Impact x (High, Medium,
Medium, (Acceptable/Unacceptable)
Medium, Low) Likelihood) Low)
Low)
Risk Mitigation and Action Plan
Mitigation Responsible Resources Monitoring & Review
Timeline
Measures Party Required Process
Final Assessment and Sign-Off
Overall Risk Profile:
High
Medium
Low
Comments/Recommendations:
Assessor’s Signature:
Date:
Reviewed by: