Risk Assessment Form

Department : RA Leader: Approved By

Process : RA Member 1: Signature
Process / Activity Location : RA Member 2:
Original Assessment Date : RA Member 3: Name
Last Review Date : RA Member 4: Designation
Next Review Date : RA Member 5: Date
Hazard Identification Risk Evaluation Risk Control
Possible Injury/ Existing Risk Additional Implementation
Ref Work Activity Hazard S L RPN S L RPN Due Date
Ill-Health Controls Controls Person

Note:
1. This form is to be completed before filling in the Risk Assessment Form.
2. The contents of the Work Activity column in the Inventory of Work Activities Form is to be copied over to the Work Activity column in the RA Form
 Ref. No

Risk Control
Remarks