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Club/Society Name: President/Captain: Contact Phone no: Regular Meeting time/s:

E-mail:

Risk Assessment Risk assessment carried out by: _____________________________________________________________________ Regular venue/s or venues for one off activities include contact details of venue if applicable ______________________________________________________________________ Activities/situation _______________________________________________________________________ HAZARD anything that can CAUSE harm RISK the chance, high, medium or low that someone will be harmed by the hazard How to use this form: 1. Identify potential hazards e.g. wiring, traffic, getting lost, ice on roads, rivers, lakes, cliffs, exposure 2. Identify those at risks e.g. students, staff, other adults, other people 3. Identify potential outcome and its likelihood and give them a numerical value. 4. Multiply the two values to arrive at a risk rating 5. Where the risk is medium or high, identify on the reverse of this form, the action required to reduce the risk, or do not proceed with the activity Potential Outcome Likelihood/ Probability Minor injury 1 Injury needing medical attention 2 Injury time off work/university 3 Serious injury/long term sickness 4 Fatality 5 Unlikely 1 Low risk Low risk Low possibility 2 Low risk Low risk Possible 3 Low risk Medium risk Probable 4 Low risk Medium risk Near certainty 5 Low risk Medium risk

Low risk

Medium risk

Medium risk

Medium risk

High risk

Low risk

Medium risk

Medium risk

High risk

High risk

Low risk

Medium risk

High risk

High risk

High risk

Hazards identified 1

Persons at risk

Risk low/medium/high

Measures taken to reduce the risk

10