RISK ASSESSMENT RECORDING FORM

Location or
Address: The Kitchen
Activity or
Situation
(1)

Hazard

Date Assessment
Undertaken: 5th March
Review
Date:9th March
Risk

(2) Who might be harmed and how?

Assessment undertaken
By: 8th March
Signature

(3) What controls exist to reduce

risk

(4) What action can be taken

To further reduce risk?

Tripping over the dogs bed in the

kitchen.

The model of the photos.

Warn the model to watch their step

as they enter the kitchen.

Move the bed out of the kitchen all

together.

Falling in the pond in the back

garden.

The model of the photos.

Warn the model to keep an eye out

for the pond.

Have someone else stood by the

pond preventing the model falling
in.

Slipping on the wet grass in the

garden.

The model of the photos.

Warn the model before she walks

on the grass

Have an extra person help her

along the grass so she doesnt
slip.

1. List hazards something with the potential to cause harm here:

Seek to quantify the level of risk the likelihood of harm arising based on the number of persons affected, how often they are exposed to the hazard and the
severity of any consequence.
2. List groups of people who are especially at risk from the significant hazards which you have identified
3. List existing controls here or note where the information may be found
4. List the risks which are not adequately controlled and the action you will take. Have regard for the level of risk, the cost of any action and the benefit you expect to
gain.

Location or
Address: The Garden
Activity or
Situation

(1)

Hazard

Tripping and falling in the fish pond in

the back garden.

Date Assessment
Undertaken: 5th March
Review
Date:

Risk

Assessment undertaken
By: 8th March
Signature

(2) Who might be harmed and how?

(3) What controls exist to reduce

risk

(5) What action can be taken

To further reduce risk?

The model of the photos.

Warn the model to be very careful

while being near the fish pond.

Take the photos on the other side

of the garden to the pond.

RISK RATING
a SEVERITY

b LIKELIHOOD

c FINAL SCORE RATING: what needs to be done

Dying or being permanently disabled

Will almost certainly happen

Serious injury/long term illness

Highly likely to happen

Temporary disability/3 days off sick

Not so likely

Will need medical attention

Even less likely

Minor injury eg. Bruise, graze

Unlikely to happen at all

16-25 Stop! Do not start activity again until risk is

controlled
10-15 High risk level, High priority. Take action
straight away to control the risk
6-9
Medium risk level. Tighten up controls and
make a plan to do something about risk
3-5
Fairly low risk level. Low priority but keep
possible action in mind
1-2
Low or trivial risk. No further action
required.

SO: a x b = c
Action Required

Responsible Person

Date for Completion