GENERIC RISK ASSESSMENT FORM blank by GnuCI3

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									RISK ASSESSMENT FORM                                                                                     (insert your logo here)


Area of activity assessed:
Assessment Date:
Persons who may be affected by the activity:




SECTION 1: Identify Hazards – Consider the activity or work area and identify if any of the hazards listed below are significant
(mark all the boxes that apply)

1 Lone                 7     Portable tools /     13   Fixed machinery or         19   Indoor activity         25   Occupational
  working                    equipment                 lifting equipment               sessions                     stress
2 Lighting             8     Electrical           14   Layout, storage,           20   Outdoor activity        26   Physiological
  levels                     equipment                 obstructions                    sessions
3 Slips and            9     Food                 15   Hazardous fumes,           21   Outdoor work            27   Travel
  trips                      preparation               dust and chemicals              Extreme weather
4 Heating /            10    Condition of         16   Fire hazards &             22   Home Visits             28   Financial
  ventilation                buildings                 flammable material
5 Vehicles /           11    Condition of         17   Violence / verbal          23   Manual handling         29   Safeguarding
  Driving                    contents                  assault                         loads
6 Falling              12    Display screen       18   Fall from height           24   Manual handling         30   Other- specify
  objects                    equipment                                                 people
SECTION 2: Risk Controls – For each hazard identified in Section 1, complete Section 2

Hazard    Hazard Description Existing controls to reduce risk                                Risk level Further action
No.       and possible risks                                                             High Med Low needed to reduce
          identified                                                                                    risks




Name of Assessor                                                          Signed
Review date

								
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