Risk Assessment Record Sheet

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					                                                                                        Risk Assessment Record Sheet
ACTIVITY / SITUATION BEING ASSESSED


DATE OF LAST ASSESSMENT
DATE OF THIS ASSESSMENT
PERSON CARRYING OUT ASSESSMENT


HAZARDS



  HAZARD IDENTIFIED                           PERSONS AT RISK                                        WORST CASE OUTCOME                                     LIKELIHOOD / PROBABILITY                 ACTION


                                                                                                Major to   Major to           Environment     Likely/
                          Everyone    Young   Contractor   Operative   Public/visitor   Fatal    Many       One       Minor     al / Plant   Frequent   Probable   Possible    Remote   Improbable




Checked By:
Signed:
Date: