RISK ASSESSMENT TEMPLATE

Activity: RA no: Revision: Date:

NOTE: All Current Risk ranked above C-15 must have additional control measures: Risk = Consequence x Probability (R = C x P)
Tolerable Risk (Low) = 1-6, Medium = 8 -12, (Methods statement), Intolerable Risks (High) = 15 – 25 (Method Statement plus additional Control
Measures in place)

Consequence (Severity) Rating Factors (5)

No Safety Health Environ. Financial
Consequence Frequency/Probabil
Probably RatingFactors (5) ity
Equip. Product. (Severity)
No Frequency
`

1 First Aid Immediate Minor <AED 1k <1 hr A B C D E

2 Medical Temporary Short term <AED50K 1-2 hrs A (1) Practically impossible or Once in 10
years R=CxP 1 2 3 4 5
3 Lost Time Short term Long term >AED300k 2-4 hrs B (2) Not likely or Once per year 5 5 10 15 20 25
4 Disability Long term Serious >AED500k 4-8 hrs C (3) Could happen or Monthly 4 4 8 12 16 20
5 Fatality Fatal Catastrophic >AED1m >1 shift D (4) Has happened or Weekly
3 3 6 9 12 15
E (5) Common or Daily
2 2 4 6 8 10
1 1 2 3 4 5

Assessed by (name): Approved by (name):

Designation: Designation:
Signature: Signature:
Date: Date:

Reference: Revision: 01.01 Information Classification:

Date: Author: Page 7 of 7