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Risk Assessment Template

1. The risk assessment form identifies hazards like falling from the mezzanine, tripping over equipment, falling down stairs, and equipment overheating during a photo shoot. 2. Cast and crew are especially at risk of harm from these hazards. Controls listed include railings, clearing equipment away, and ensuring lighting equipment is off when not in use. 3. The form rates risks on a scale and lists actions needed to further reduce risks rated medium or higher, like installing additional railings or banning leaning on existing railings. It assigns responsible parties and dates to complete risk-reducing actions.

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Jack Merrill
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81 views

Risk Assessment Template

1. The risk assessment form identifies hazards like falling from the mezzanine, tripping over equipment, falling down stairs, and equipment overheating during a photo shoot. 2. Cast and crew are especially at risk of harm from these hazards. Controls listed include railings, clearing equipment away, and ensuring lighting equipment is off when not in use. 3. The form rates risks on a scale and lists actions needed to further reduce risks rated medium or higher, like installing additional railings or banning leaning on existing railings. It assigns responsible parties and dates to complete risk-reducing actions.

Uploaded by

Jack Merrill
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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RISK ASSESSMENT RECORDING FORM

Location or
Address: Mezzanine in the design block
Activity or
Situation: Photo shoot
(1)

Hazard

Risk

Date Assessment
Undertaken: 05/01/2016
Review
Date:05/01/2016
(2) Who might be harmed and how?

Assessment undertaken
By: Jack Merrill
Signature

(3) What controls exist to reduce


risk

(4) What action can be taken


Do not lean on railing

Falling off of the Mezzanine

Cast and Crew

Railing on side of mezzanine

Falling over Lighting equipment

Cast and crew

Make sure its out of the way when


not in use

Falling down stairs

Cast and crew

Use Handrails when going up


stairs

Knocking into equipment

Cast and crew

Ensure all equipment is away when


not in use

Overheating of lighting equipment

Cast and crew

Ensure no members of cast or


crew touch the lighting equipment
during or directly after it is in use

To further reduce risk?

Ensure all Lighting equipment is


turned off when not in use

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.

(1)

Hazard

Risk

(2) Who might be harmed and how?

(3) What controls exist to reduce


risk

(5) What action can be taken


to further reduce risk?

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

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