GENERAL RISK ASSESSMENT TEMPLATE

Company: [COMPANY NAME]
Assessment Area/Activity: [AREA/ACTIVITY]
Assessment Date: [DATE]
Assessed by: [NAME & POSITION]
Review Date: [DATE]
Assessment Reference: [REF NUMBER]

INSTRUCTIONS:
1. Identify all hazards in the workplace or activity
2. Determine who might be harmed and how
3. Evaluate the risk using the risk matrix
4. Decide on control measures following hierarchy of controls
5. Record findings and implement controls
6. Review and update regularly

RISK ASSESSMENT MATRIX:

LIKELIHOOD SCALE:
1 - Rare: May occur only in exceptional circumstances
2 - Unlikely: Could occur at some time
3 - Possible: Might occur at some time
4 - Likely: Will probably occur in most circumstances
5 - Almost Certain: Expected to occur in most circumstances

CONSEQUENCE SCALE:
1 - Negligible: No injuries, minimal impact
2 - Minor: First aid treatment, minor impact
3 - Moderate: Medical treatment required, moderate impact
4 - Major: Extensive injuries, major impact
5 - Catastrophic: Death or permanent disability, severe impact

RISK RATING = LIKELIHOOD × CONSEQUENCE

RISK LEVELS:
• LOW RISK (1-6): Monitor and maintain existing controls
• MEDIUM RISK (7-12): Additional controls may be required
• HIGH RISK (13-25): Immediate action required

HAZARD IDENTIFICATION CHECKLIST:

PHYSICAL HAZARDS:
□ Slips, trips, and falls
□ Working at height
□ Moving machinery
□ Vehicles and mobile equipment
□ Manual handling
□ Struck by falling objects
□ Cuts and lacerations
□ Burns and scalds
□ Noise exposure
□ Vibration
□ Radiation
□ Temperature extremes
□ Pressure systems
□ Confined spaces

CHEMICAL HAZARDS:
□ Toxic substances
□ Corrosive materials
□ Flammable liquids/gases
□ Carcinogenic substances
□ Respiratory sensitizers
□ Skin sensitizers
□ Asphyxiants
□ Dust and fumes
□ Vapors and gases

BIOLOGICAL HAZARDS:
□ Bacteria and viruses
□ Fungi and molds
□ Parasites
□ Contaminated materials
□ Animal/insect bites
□ Allergenic substances
□ Infectious diseases

ERGONOMIC HAZARDS:
□ Repetitive motions
□ Awkward postures
□ Forceful exertions
□ Contact stress
□ Vibration exposure
□ Poor workstation design
□ Inadequate lighting
□ Temperature extremes

PSYCHOSOCIAL HAZARDS:
□ Work-related stress
□ Workplace violence
□ Harassment/bullying
□ Fatigue
□ Shift work
□ Workload pressures
□ Job insecurity
□ Poor communication

ENVIRONMENTAL HAZARDS:
□ Weather conditions
□ Natural disasters
□ Air quality
□ Water contamination
□ Soil contamination
□ Waste materials
□ Emergency situations

RISK ASSESSMENT FORM:

HAZARD 1:
Hazard Description: [Describe the specific hazard]
Location: [Where is the hazard located]
Activity: [What activity creates the hazard]
Who might be harmed: [Workers, visitors, contractors, public]
How harm could occur: [Describe potential incident scenarios]
Number of people exposed: [Estimate number]
Frequency of exposure: [Daily, weekly, monthly, occasional]

Current Control Measures:
• [List existing controls - elimination, substitution, engineering, administrative, PPE]
• [Include training, procedures, equipment, etc.]
• [Note effectiveness of current controls]

Risk Evaluation (Current):
Likelihood: [1-5] ___
Consequence: [1-5] ___
Risk Rating: [L × C] ___
Risk Level: [Low/Medium/High] ___

Additional Control Measures Required:
Priority: [High/Medium/Low]
Control Type: [Elimination/Substitution/Engineering/Administrative/PPE]
Description: [Specific control measure]
Responsible Person: [Name]
Target Date: [Date]
Resources Required: [Budget, equipment, training, etc.]

Residual Risk (After Additional Controls):
Likelihood: [1-5] ___
Consequence: [1-5] ___
Risk Rating: [L × C] ___
Risk Level: [Low/Medium/High] ___

HAZARD 2:
[Repeat format for each identified hazard]

HAZARD 3:
[Continue for all hazards identified]

ACTION PLAN SUMMARY:

HIGH PRIORITY ACTIONS (Immediate - within 24 hours):
Action: [Description]
Responsible: [Name]
Target Date: [Date]
Status: [Not Started/In Progress/Complete]
Verification: [How will completion be verified]

MEDIUM PRIORITY ACTIONS (within 30 days):
Action: [Description]
Responsible: [Name]
Target Date: [Date]
Status: [Not Started/In Progress/Complete]
Verification: [How will completion be verified]

LOW PRIORITY ACTIONS (within 90 days):
Action: [Description]
Responsible: [Name]
Target Date: [Date]
Status: [Not Started/In Progress/Complete]
Verification: [How will completion be verified]

CONSULTATION RECORD:
Workers Consulted: [Names and positions]
Date of Consultation: [Date]
Method of Consultation: [Meeting, survey, interview]
Key Issues Raised: [Summary of worker input]
Actions Taken: [How input was addressed]

TRAINING REQUIREMENTS:
Training Needed: [Specific training requirements]
Target Audience: [Who needs training]
Training Provider: [Internal/external]
Completion Date: [Target date]
Competency Assessment: [How competency will be verified]

MONITORING AND REVIEW:
Monitoring Method: [How risks will be monitored]
Monitoring Frequency: [Daily, weekly, monthly]
Responsible Person: [Name]
Review Triggers: [Incidents, changes, time-based]
Next Review Date: [Date]

EMERGENCY PROCEDURES:
Emergency Contacts: [List relevant emergency numbers]
First Aid Arrangements: [Location of first aid, trained personnel]
Evacuation Procedures: [Brief description]
Incident Reporting: [How to report incidents]
Emergency Equipment: [Location and type]

REGULATORY COMPLIANCE:
Applicable Regulations: [List relevant regulations/standards]
Compliance Status: [Compliant/Non-compliant/Partial]
Required Actions: [Actions needed for compliance]
Inspection Requirements: [Regulatory inspection schedules]
Documentation Requirements: [Required records]

COMMUNICATION PLAN:
Information Sharing: [How findings will be communicated]
Target Audience: [Workers, management, contractors]
Communication Method: [Meetings, notices, training]
Responsible Person: [Name]
Timeline: [When communication will occur]

COST-BENEFIT ANALYSIS:
Control Measure: [Description]
Implementation Cost: [Estimated cost]
Ongoing Costs: [Annual costs]
Benefits: [Injury prevention, compliance, productivity]
Payback Period: [Time to recover investment]
Priority Ranking: [High/Medium/Low]

APPROVAL AND SIGN-OFF:

Risk Assessment Completed by:
Name: _________________ Position: _________________
Signature: _________________ Date: _________________

Reviewed by Supervisor:
Name: _________________ Position: _________________
Signature: _________________ Date: _________________

Approved by Manager:
Name: _________________ Position: _________________
Signature: _________________ Date: _________________

Safety Department Review:
Name: _________________ Position: _________________
Signature: _________________ Date: _________________

DISTRIBUTION:
□ Department Manager
□ Supervisor
□ Safety Department
□ Affected Workers
□ Contractors (if applicable)
□ Management
□ File Copy

DOCUMENT CONTROL:
Document ID: RA-GEN-[NUMBER]
Version: 1.0
Created: [DATE]
Last Modified: [DATE]
Next Review: [DATE]
Retention Period: [YEARS]

APPENDICES:
A. Site/Area Maps
B. Photographs of Hazards
C. Equipment Specifications
D. Safety Data Sheets
E. Regulatory Requirements
F. Training Records
G. Incident History
H. Consultation Records

NOTES:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________