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Basic Risk Assessment Template

March 2008 (Creativebias)

Basic Risk Assessment Template

This form must be completed for all areas and specific projects and activities.

Area, Project or Activity: _________________________________________________

Who is undertaking the risk assessment?: ____________________________________

Basic Assessment:

1. Are there any electrical hazards? Yes/No
2. Are there any hazards due to extremes of temperature
(e.g. welding or freezing) or any special fire risks?
3. Are there any mechanical hazards involving nipping, impact,
entrapment, heavy weights or moving parts?
4. Are there any chemical hazards or COSHH related substances? Yes/No
5. Are there any hazards that may cause medical alarm*?
(* Medical factors can be treated confidentially.)
6. Is part of the work out of doors? Yes/No
7. Are there any special risks or hazards? Yes/No

If the answer to any of the above is Yes, a full Risk Assessment must be carried out.

The following participated in this assessment:

Name: _________________________________________________
Position: _________________________________________________
Signature: _________________________________________________
Date: _________________________________________________

The original of this form must be deposited with the Safety Secretary. A copy must be posted near the activity to which it refers

Date of Assessment: _________________________________________________


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