Name

End-of-course date

Training provider
Total
marks

Risk assessment form

Marks

Assessors name

Description of process, activity or task to be risk assessed

Describe the location
where the activities are
taking place

Describe the activities

being performed

Describe the
equipment and/or
substances being used

Describe the people

involved in these
activities (and others
who might be affected)

Date

Risk assessment form

Who might be
harmed?

Equipment and
substances

Activities

Location

Description of hazard
and hazardous event

*Likelihood x Consequence = Risk

What risk controls

are currently in
place?

Current risk
rating*
L

Are further
controls needed?

Date to be
completed by

Residual risk
rating*
L

Marks

Risk Rating Calculator

Likelihood that hazardous event will occur

Consequence of hazardous event

very unlikely

insignificant no injury

unlikely

minor minor injuries needing first aid

fairly likely

moderate up to three days absence

likely

major more than seven days absence

very likely

catastrophic death

Action Level Table

Risk rating

Action

2025

Stop stop activity and take immediate action

1516

Urgent action take immediate action and stop activity if necessary, maintain existing controls rigorously

812

Action improve within specified timescale

36

Monitor look to improve at next review or if there is a significant change

12

No action no further action but ensure controls are maintained and reviewed

Example risk assessment

Activities

Description of hazard
and hazardous event
Filling car with petrol,
leading to spillage

Who might be
harmed?
Person filling vehicle
and others on
forecourt

What risk controls

are currently in
place?
Auto pump cut off,
signage and plastic
gloves

Current risk
rating*
L
4

C
2

Are further
controls needed?

Date to be
completed by

Residual risk
rating*

R
8

L
Make available
paper towels, sand
and absorbent
material

By next week

C
2

R
6