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Hazard and Risk - Sample Risk Assessment Form

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How can risks be assessed?

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Risks should be systematically identified and reviewed to ensure those things, activities, situations, processes, etc. that cause harm to people or property are controlled. One way to ensure that all risks are evaluated in the same way is to use a risk assessment form. This procedure should be carried out by someone who is experienced and fully familiar with the activity (e.g., a "competent person").

Please note: see the OSH Answers Risk Assessment for more information about risk assessments in general, and how to rank hazards.

Is there a procedure for identifying risks?

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There is no one way to assess risks, and there are many risk assessment tools and techniques that can be used. Choose the method that best matches your situation. In all cases, the risk assessment should be completed for any activity, task, etc. before the activity begins.

Step Action Deliverable
1 Identify hazards and their potential for causing harm. An inventory of hazards.
2 Rank hazards by priority. This list will be useful in planning further action.
3 Determine hazard elimination or risk control measures. A record of hazard elimination or risk control measures at various locations.
Adequacy of hazard elimination or risk control measures.
A list of controls required or recommended by legislation, standards, best practices, or organizational policies.
4 Eliminate the hazard, or implement risk controls. Controls are in place and functioning appropriately.
5 Measure the effectiveness of controls. Monitor periodically to confirm controls continue to function.
6 Make changes to improve continuously. Monitor for improvements.

What is a sample risk assessment form?

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The following is a sample. Be sure to customize it for your needs at your workplace. The goal is to answer all of the questions below.  How you actually assess the risks can vary from situation to situation, and may include the technique of brainstorming, or using a checklist or an assessment matrix. Document the process used, and how decisions were reached.

Sample Risk Assessment Form
Name of person doing assessment:




Date:
Activity / Procedure being assessed:
Known or expected hazards and risks associated with the activity:
Possible consequences: What are the possible consequences? How likely are these consequences to occur? What is the possible severity of the harm?
Who is at risk?
Measure to be taken to eliminate the hazard or lower the level of risk:
Is there a risk of the control measures failing?  What would the consequences be?




Training requirements:
Level of risk remaining:
Action to be taken in an emergency:
References, if any:
Signature of Assessor:
  • Fact sheet last revised: 2017-04-03