RISK ASSESSMENT (Form-1012)
Risk is the possibility of loss or injury occurring to a person or property when exposed to a hazard. To determine how serious the risk (or level of risk) could be in a certain situation, please complete the Risk Assessment below.
Date of Risk Assessment:
*
-
Day
-
Month
Year
Date
Name of person completing this risk assessment:
*
First Name
Last Name
Subject of Risk Assessment:
*
Enter name of person, type of task/activity, type of environment
What is the risk?
*
Describe the type of harm or loss to person or property under the CURRENT circumstances. Include multiple risks, if required.
Using the Risk Matrix below, determine the level of risk:
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Very High
High
Medium
Low
Can control measures be put in place to reduce the level of risk in the future?
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Yes
No
Unsure
If YES, please list the control measures here. If NO or unsure, please give reasons for why:
*
E.g., Can the risk be eliminated, or the support environment, type and frequency be modified? Do staff need additional training or information to help reduce the risk?
Person responsible for implementing control measures/s:
First Name
Last Name
Control measures DUE by:
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Day
-
Month
Year
Date
Level of Risk AFTER implementing control measures:
Very High
High
Medium
Low
Manager's confirmation control measures COMPLETED:
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Day
-
Month
Year
Date
Submit
Should be Empty: