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Risk Assessment

Workplace hazard identification and risk control record

Company logo

PAGE 1 OF 2

Assessment Details

Task / activity

Location

Department

Assessment date

Assessor name

Review date

Risk Matrix Reference

Likelihood

1 = Rare · 2 = Unlikely · 3 = Possible
4 = Likely · 5 = Almost certain

Consequence

1 = Insignificant · 2 = Minor · 3 = Moderate
4 = Major · 5 = Catastrophic

Risk rating L × C

Risk Assessment Register

Identify each hazard, rate likelihood and consequence, record existing controls and any additional controls needed.

#	Hazard / risk	L (1-5)	C (1-5)	Risk (L×C)	Existing controls	Additional controls needed	Responsible
1
2
3
4
5
6
7
8

Risk Assessment - Page 2 of 2

Assessor

Date

Risk Assessment Register (Continued)

#	Hazard / risk	L (1-5)	C (1-5)	Risk (L×C)	Existing controls	Additional controls needed	Responsible
9
10
11
12
13
14

Action Plan

Record any additional actions, follow-up items or notes below.

Declaration

I confirm that the hazards associated with this task or activity have been identified, the risks have been assessed using the likelihood and consequence matrix, and appropriate control measures have been determined. All workers involved in the task have been consulted and made aware of the identified hazards and required controls.

Assessor sign-off

Print name

Signature

Date

Reviewer / manager sign-off

Print name

Signature

Date