Doc Ref No

bluu-IMS-RA/WS-HSE-0017-1

Owner

HSE Dept.

Rev Date

Rev

Safe System of Work

Risk Assessment Worksheet

05-01-2016

Element of Work

Risk Assessment No

Projects Name

Method Statement Ref (If Applicable)

RS Author

No

Activities

Rev

Designation

Hazards

Who Might
be Harmed

Risk

Date

Initial Risk
Rating

Residual Risk

Control Measures

RR

Action By

RR

Yes

1
2
3

Very unlikely
Unlikely
Likely
Very likely

Likelihood

5
No
1
2
3
4
5

Almost certain
Severity
First aid injury or illness
Minor injury or illness
3 day injury or illness
Major injury or illness
Fatality, disablement injury, RIDOR

Prepared By

No
1
2
3
4
5
6
7

Risk Factor Matrix

Risk Priority

Methodology
Identify Hazards.
List Hazard Event
Calculate Risk Factor with Initial Risk Rating. i.e.
Detail Controls.
Calculate Residual Risk Rating with final risk rating.

Enter Risk Priority.

Evaluate Acceptability of Risk.

Checked By

Severity

No
1
2
3
4

5
4

10
8

15
12

20
16

25
20

12-25
5-10

3
2
1

6
4
2

9
6
3

12
8
4

15
10
5

1-4

Risk
Accepted?

High Risk
Medium Risk
Low Risk

Likelihood

Approved By

Name
Designation
Signatures
Date

___________________________________________________________________________________________________________________________________________
bluu HSE Depart.
Management Risk Assessment
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