Hazard and Risk - Sample Risk Assessment Form
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How can risks be assessed?
Back to topAfter hazards are identified, the risks associated with those hazards should be systematically reviewed to ensure those things, activities, situations, processes, tasks, etc. that cause harm to people or property are controlled. One way to ensure that all risks are evaluated in the same way is to use a risk assessment form. This procedure should be carried out by someone who is experienced and fully familiar with the activity (e.g., a "competent person").
Please note: see the OSH Answers Risk Assessment for more information about risk assessments in general, and how to rank hazards.
Is there a procedure for assessing risks?
Back to topThere is no one way to assess risks, and there are many risk assessment tools and techniques that can be used. Choose the method that best matches your situation. In all cases, the risk assessment should be completed for any activity, task, etc. before the activity begins.
| Step | Action | Deliverable |
|---|---|---|
| 1 | Identify hazards and their potential for causing harm. | An inventory of hazards. |
| 2 | Assess the risk of each hazard and rank hazards by priority (consider the probability of harm and severity of harm). | A ranked list of hazards. This list will be useful in planning further action. |
| 3 | Determine hazard control measures. | 1. A record of hazard control measures at various locations. 2. Evaluation of the adequacy of hazard control measures. Consider the hierarchy of controls, and controls required or recommended by legislation, standards, good practices, or organizational policies. |
| 4 | Implement hazard controls. | Controls are in place and functioning appropriately. |
| 5 | Measure the effectiveness of controls. | Monitor periodically to confirm controls continue to function effectively. |
| 6 | Make changes to improve continuously. | Monitor for improvements. |
What is a sample risk assessment form?
Back to topThe following is a sample. Be sure to customize it for your needs at your workplace. How you actually assess the risks can vary from situation to situation, and may include the technique of brainstorming, or using a checklist or a risk matrix. Document the process used, and how decisions were reached.
Sample Risk Assessment Form
Name of person(s) doing assessment:_____________________________________________________________
___________________________________________________________________________________________
Date: ______________________________________________________________________________________
Location:__________________________________________________________________________________
Job, activity, task or procedure being assessed: _____________________________________________________
___________________________________________________________________________________________
____________________________________________________________________________________________
Hazards, Risks, and Controls:
List details about each identified hazard below, including the step or task they are associated with, what they are and who they may impact, what the potential consequences are if workers are exposed to the hazard, the level risk (e.g., can use risk matrix below), the priority (hazards with the highest risk should be the top priority to address), and what are the recommended hazard controls to eliminate or reduce the risk.
Step or task |
Hazard
| Consequences or harm | Risk | Priority | Hazard Controls |
EXAMPLE: Working at heights while on a ladder
|
Safety hazard: falling from heights |
Serious injury due to a fall
|
High risk
|
1
| Follow the hierarchy of controls for working at heights Elimination: when possible, perform work from the ground. Engineering controls: use an elevating work platform when appropriate. Administrative controls: development of fall protection plans, safe work procedures, emergency response plans for working at heights, and adequate training (including working heights and fall protection training, elevating work platform training, ladder safety, training on safe work procedures and emergency response, etc.). Personal protective equipment: fall arrest system and equipment, head protection, high-visibility clothing, protective footwear, face and eye protection, emergency response equipment, and other appropriate equipment for the job. |
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Additional Notes:______________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Signature of health and safety committee or representative:_____________________________________________
____________________________________________________________________________________________
Signature of assessor(s): ________________________________________________________________________
____________________________________________________________________________________________
Date completed:_______________________________________________________________________________
Example Risk Matrix:
Low Severity | Medium Severity | High Severity | |
Low Probability | Very Low Risk | Low Risk | Medium Risk |
Medium Probability | Low Risk | High Risk | High Risk |
High Probability | Medium Risk | High Risk | Immediately Dangerous |
Severity ratings:
- High severity: fatal disease or injury, permanent disability, irreversible health effects, major fracture, poisoning, significant loss of blood, or serious head injury.
- Medium severity: sprain, strain, localized burn, dermatitis, asthma, injury requiring limited days off work
- Low severity: an injury that requires first aid only; short-term pain, irritation, or dizziness
Probability ratings:
- High probability: likely to be experienced once a year or more by an individual
- Medium probability: may be experienced once every five years by an individual
- Low probability: may occur once during a working lifetime
- Fact sheet last revised: 2025-01-21
