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Blank Risk Assessment Template

This document is a health and safety risk assessment for a machine or equipment. It lists potential hazards, the causes and injuries of each hazard, and the current and residual risk levels with and without control measures. Sign off sheets are included for the risk assessment team and any employees or customers affected. The assessment is meant to be reviewed periodically.

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186 views4 pages

Blank Risk Assessment Template

This document is a health and safety risk assessment for a machine or equipment. It lists potential hazards, the causes and injuries of each hazard, and the current and residual risk levels with and without control measures. Sign off sheets are included for the risk assessment team and any employees or customers affected. The assessment is meant to be reviewed periodically.

Uploaded by

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

Health & Safety Risk Assessment


Work Activity Being RA Revision
Assessed (Process): SSW Ref: Number:

Persons at Risk: Date of Assessment: Date of Review:

RISK Control Measures RISK


What is the Hazard? Cause and Potential Injury?
H, M, L H, M, L
RISK Control Measures RISK
What is the Hazard? Cause and Potential Injury?
H, M, L H, M, L
Low Medium High
1 to 4 5 to 9 10 to 25
Risk Risk Risk
Notes:
Photo of the process / machine / equipment relating to this risk assessment.
Very
Likely 5 10 15 20 25
5

Likely
4 8 12 16 20
4

Feasible
3 6 9 12 15
3
LIKELIHOOD

Slight
2 4 6 8 10
2

Very
Unlikely 1 2 3 4 5
1

Insignificant Minor Significant Major Critical


1 2 3 4 5

SEVERITY
Risk Assessment Sign-Off Sheet

Risk Assessment Team Names Risk Assessment Team Signature Date

Employee / Customer Name Employee / Customer Signature Date

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