Date
Issue
RISK ASSESSMENT FORM
LOCATION:
HAZARD
Hazard from: Premises, Plant,
Equipment, Other
Persons etc.
Name: Signed:
AT RISK
RISK CONTROL
Who, how many and when are
persons at risk from the hazards
identified
Control By: Training, Supervision, Safety Equipment,
Health Monitoring, Safe Working Procedures, Hygiene
etc.
PROBABILITY
WORST CASE OUTCOME
Worst Case
Outcome
Likelihood
Risk
Action
Level
Date: Further action required Y/N NO
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