Participant Individual Risk Assessment

Once this form is submitted, the COVEY team member completing the form will receive an email of the form, with an editable link at the very bottom.

Please save that email and use the editable link every 3 months (or sooner) to review, edit and resubmit this risk assessment. This will save duplication of work as you will only have to edit the things that have changed and all other information will remain on the form.

Your Service Manager's Name:

Your COVEY email address:

example@example.com

Participant name:

First NameLast Name

Which COVEY Services apply to the participant (tick all that apply)

Please detail one risk at a time. There will be the opportunity to detail additional risks later.

Please give details of the risk:

Who is at risk?

If you are unsure of how to determine and calculate the risk rating below, please find a guidance document here:

COVEY's Risk Rating Guidance

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating)

**If this risk rating is over 16. Please make sure you inform your line manager.** (2)

Control measures in place:

Additional controls required:

Name of person responsible for actioning the above:

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Would you like to add a 2nd risk?

Please give details of the risk (2):

Who is at risk? (2)

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating) (2)

**If this risk rating is over 16. Please make sure you inform your line manager.** (2)

Control measures in place (2):

Additional controls required (2):

Name of person responsible for actioning the above (2):

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Would you like to add a 3rd risk?

Please give details of the risk (3):

Who is at risk? (3)

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating) (3)

**If this risk rating is over 16. Please make sure you inform your line manager.** (3)

Control measures in place (3):

Additional controls required (3):

Name of person responsible for actioning the above (3):

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Would you like to add a 4th risk?

Please give details of the risk (4):

Who is at risk? (4)

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating) (4)

**If this risk rating is over 16. Please make sure you inform your line manager.** (4)

Control measures in place (4):

Additional controls required (4):

Name of person responsible for actioning the above (4):

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Would you like to add a 5th risk?

Please give details of the risk (5):

Who is at risk? (5)

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating) (5)

**If this risk rating is over 16. Please make sure you inform your line manager.** (5)

Control measures in place (5):

Additional controls required (5):

Name of person responsible for actioning the above (5):

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Would you like to add a 6th risk?

Please give details of the risk (6):

Who is at risk? (6)

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating) (6)

**If this risk rating is over 16. Please make sure you inform your line manager.** (6)

Control measures in place (6):

Additional controls required (6):

Name of person responsible for actioning the above (6):

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Would you like to add a 7th risk?

Please give details of the risk (7):

Who is at risk? (7)

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating) (7)

**If this risk rating is over 16. Please make sure you inform your line manager.** (7)

Control measures in place (7):

Additional controls required (7):

Name of person responsible for actioning the above (7):

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Would you like to add an 8th risk?

Please give details of the risk (8):

Who is at risk? (8)

Likelihood	Severity
1 = Rare	1 = Unlikely
2 = Unlikely	2 = Minor
3 = Probable	3 = Moderate
4 = Likely	4 = Major
5 = Highly Likely	5 = Fatal

What is the risk level? (likelihood rating x severity rating) (8)

**If this risk rating is over 16. Please make sure you inform your line manager.** (8)

Control measures in place (8):

Additional controls required (8):

Name of person responsible for actioning the above (8):

First NameLast Name

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Name of staff member completing this risk assessment:

First NameLast Name

Date of Completion:

Date

Review Date:

Date

If more than one person is responsible, please add additional names below:

Name:

First NameLast Name

Name:

First NameLast Name

Participant Individual Risk Assessment

Details of the Risk

Details of Risk (2)

Details of Risk (3)

Details of Risk (4)

Details of Risk (5)

Details of Risk (6)

Details of Risk (7)

Details of Risk (8)