SITE RISK ASSESSMENT TEMPLATE

RISK MATRIX TEAM DETAILS

Fatality(ies) Catastrophic 5 5 10 15 20 25 PROJECT NAME
Hospital medical attn; > 3 days off duty Major 4 4 8 12 16 20 NAME OF SITE
Hospital medical attn; < 3 days off duty Significant 3 3 6 9 12 15 SITE ID
SEVERITY (IMPACT) First aid attn; min lost time; Minor 2 2 4 6 8 10 RISK ASSESSOR NAME
No medical attn; Insignificant 1 1 2 3 4 5 DATE
1 2 3 4 5 TIME
Rare Unlikely Possible Likely Certain NO OF TEAM MEMBERS ON SITE
PROBABILITY (LIKELIHOOD)
RISK = SEVERITY X PROBABILITY
RISK CLASSIFICATION (Select Applicable) RISK RATING
Property
TASK/ACTIVITY HAZARD DESCRIPTION Safety Damage Fire Environment Health Security Other 1-4 5-8 9 - 12 13 - 25 RISK MITIGATION/CONTROLS PUT IN PLACE