PART 1: TASK RISK ASSESSMENT

Company……………………………………. Site name…………………………………....

A description/labelled sketch of the location(s)

A description of the people who work in or visit the area on a regular basis or
from time to time and how often they’re there

Signature :_________________

Name: ___________________
 PART 1: TASK RISK ASSESSMENT

A description of permanent and temporary pieces of equipment and

substances used in your work environment

A description of the activities carried out within your work environment

Signature :_________________

Name: ___________________
 Hazard Checklist: locations(s) Part 2
The location(s) you manage

Company: Department: Site name:

Description of the Description of the hazard Number and occupation of Risk assessment
location (in relation to the location) people affected recommended?
(in relation to the location) (If no, please explain)

Yes No

Yes No

Yes No

Signature:__________________
 Hazard Checklist: equipment and substances Part 3
Permanent and temporary pieces of equipment and substances used in the work environment

Company: Department: Site name:

Description of the Description of the hazard Number and occupation of Risk assessment
equipment/substances (in relation to the equipment/substance) people affected recommended?
(in relation to the equipment/substance) (If no, please explain)

Yes No

Yes No

Yes No

Signature:__________________
 Hazard Checklist: activities Part 4
Activities carried out within your work environment
Company: Department: Site name:

Description of the Description of the hazard Number and occupation of Risk assessment
Work activity (in relation to the work activity) people affected recommended?
(in relation to the work activity)

√ Yes No

√ Yes No

√ Yes No

Signature:__________________
 Risk assessment form Part 5
Company: Department: Site name:

Work Hazard, hazardous event and People Assessment of risk Are risk controls
(in relation to the work activity)
activity expected consequence affected Likelihood Consequence Risk required?
(in relation to the work activity) (in relation to the work X =
level level level
activity)

Occupation:
√ Yes No

Number:

Occupation:
√ Yes No

Number:

Occupation:
√ Yes No

Number:

Date: Time: Review period: Date of next review:

Assessor’s name: Position: Signature:

 Risk control form Part 6

Company: Department: Site name:

Work activity Existing Further risk Residual risk Description of

(in relation to the work activity)
and risk level risk controls controls required Probable Potential New risk monitoring required
(from risk (in relation to the work (in relation to the work activity) X = (in relation to the residual risk)
Likelihood Consequence level
assessment form) activity)

Risk level: Frequency:

Risk level: Frequency:

Risk level: Frequency:

Date: Review period: Date of next review:

Assessor’s name: Position: Signature: