V9

RISK ASSESSMENT
ACTIVITY

HAZARD

WALKING DOWN THE STAIRS

TRIPPING DOWN THE

STAIRS

RISK
H/M/L

PRECAUTIONS

HOLD ONTO THE RAILING

IN
PLACE

YES

REVIEW
DATE

28TH JAN

REVIEWER

SAM
ROSE

28TH JAN
FALLING OVER ON THE
STREET

MISSING YOUR FOOTWORK

Please leave this section blank:

Risk Assessment checked by: Name ..
KEY:

Activity :
Hazard :
Risk:
Precautions:
In Place:
Review Date:
Reviewer:

WATCH YOUR FOOTWORK

YES

Signed .

SAM
ROSE

Date

Describe the component part of your pursuit.

List the things you anticipate might cause harm or the things associated with your activity that have the potential to cause harm. Consider the likely
harm.
Assess the risk as either H (High), M (Medium) or L (Low). When concluding your assessment consider all of the circumstances.
Consider what you could do to minimise / negate the risk.
Will the precautionary measures be in place at the time of the activity?
When would it be reasonable to review your assessment? Remember it might be whilst you are undertaking the activity.
Name of the person responsible for completing the risk assessment.

A copy of this form should be taken on the activity or visit by the Reviewer.
V9/PALL/sspi/reviewedOct2010