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Culture Documents
BLANK Risk Assessment Form
BLANK Risk Assessment Form
Group Name:
Original assessment date:
Risk Rating
Hazard
Persons
affected
Existing
controls
A.
Likely
severit
y of
injury
(1 to
3)
B.
Likely
Occur
rence
(1 to
3)
C.
Risk
Rating
(A) x (B)
Additional
controls
Person
responsible
Date
Risk Rating
Hazard
Persons
affected
Existing
controls
A.
Likely
severit
y of
injury
(1 to
3)
B.
Likely
Occur
rence
(1 to
3)
C.
Risk
Rating
(A) x (B)
Additional
controls
Person
responsible
Date
Risk Rating
Hazard
Persons
affected
Score
Column A: Severity of
Injury:
Column B: Likely
Occurrence:
Existing
controls
A.
Likely
severit
y of
injury
(1 to
3)
B.
Likely
Occur
rence
(1 to
3)
C.
Risk
Rating
(A) x (B)
Additional
controls
Person
responsible
3
Major Injury or death
2
Injury requiring medical treatment
1
Minor or no injury
Date