S.

No Criteria Tick When

done
Part 1: Description of the organisation and methodology used:
1.1 The Name of the organisation
1.2 The site location
1.3 Number or workers employed
1.4 The general description includes:
• products manufactured/services offered;
• types of activities;
• shift patterns
1.5 Description of the area to be included in the risk assessment
1.6 Methodology used to include:
• sources of information,
• who was consulted?
• how you decided on the additional control measures
Part 2: Risk assessment:
2.1 Record at least 10 different hazard categories (hazard categories for
this assessment are the topic headings for Elements 5 – 11 of the IG
syllabus)
2.2 The identified hazard categories are taken from at least 5 different
Elements (Elements 5 – 11 of the IG syllabus)
2.3 Hazard and the Hazard category mentioned for all rows in column 1
2.4 Who may be harmed and how they will be harmed to be mentioned
in column 2 for each hazard identified in column 1
2.5 What you are already doing to control the hazard to be mentioned in
column 3 for each hazard identified in column 1
2.6 What further controls or actions might be needed to be mentioned in
column 4 where applicable for all the identified hazards (remember
you must take account of the hierarchy of control and the prevention
and control measures in ILO-OSH 2001, Section 3.10.1 in
deciding on further controls)
2.7 Realistic timescales to be mentioned in column 5 for each control
identified in column 4
2.8 The role of the person responsible for completing each action in
column 4 to be mentioned in column 6
Part 3: Prioritise 3 actions with justification for the selection:
3.1 3 highest priority/most urgent actions selected that are taken from
Column 4 of Part 2
3.2 General Moral, legal and financial arguments provided for all
prioritised actions
3.3 Action 1:
Specific legal arguments
 • Your legal arguments must be based on the International
Labour Organization’s (ILO) Conventions, Recommendations
and Codes of Practice. You may also include country-specific
legislation but this will not be marked
3.4 Action 1:
Following information are to be included in 3rd row
• Types of injury,
• ill-health or harm likely to be seen,
• the number of workers at risk,
• how often the activity is carried out and how widespread the
risk provided for each action in likelihood and severity
• severity category
3.5 Action 1:
Following information are to be included in 4th row
• Description of how effective the action will be in controlling
the risk for each action
• Justification for the timescale
• Whether the Action will fully control the risk
3.6 Action 2:
Specific legal arguments
• Your legal arguments must be based on the International
Labour Organization’s (ILO) Conventions, Recommendations
and Codes of Practice. You may also include country-specific
legislation but this will not be marked
3.7 Action 2:
Following information are to be included in 3rd row
• Types of injury,
• ill-health or harm likely to be seen,
• the number of workers at risk,
• how often the activity is carried out and how widespread the
risk provided for each action in likelihood and severity
• severity category
3.8 Action 2:
Following information are to be included in 4th row
• Description of how effective the action will be in controlling
the risk for each action
• Justification for the timescale
• Whether the Action will fully control the risk
3.9 Action 3:
Specific legal arguments
• Your legal arguments must be based on the International
Labour Organization’s (ILO) Conventions, Recommendations
 and Codes of Practice. You may also include country-specific
legislation but this will not be marked
3.10 Action 3:
Following information are to be included in 3rd row
• Types of injury,
• ill-health or harm likely to be seen,
• the number of workers at risk,
• how often the activity is carried out and how widespread the
risk provided for each action in likelihood and severity
• severity category

3.11 Action 3:
Following information are to be included in 4th row
• Description of how effective the action will be in controlling
the risk for each action
• Justification for the timescale
• Whether the Action will fully control the risk
Part 4: Review, Communicate and Check
4.1 Realistic review date given
4.2 Reason for review date given
4.3 Indicate how the risk assessment findings will be communicated
4.4 Indicate who the risk assessment findings will be communicated to
4.5 Indicate how you will follow up to check that the identified actions
have been carried out