Professional Risk Assessment Questionnaire

Professional Risk Assessment Questionnaire
Please complete this form to help us evaluate and improve workplace safety by identifying and assessing potential risks.
Organization Name
Contact Person Full Name
First NameLast Name
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Workplace Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Assessment Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of Workplace/Industry

General Risk Assessment Table

Rows	Hazard Present?	Likelihood (1-5)	Severity (1-5)	Existing Controls in Place	Further Action Needed?
Physical Hazards (e.g., slips, trips, falls)
Chemical Hazards (e.g., substances, fumes)
Biological Hazards (e.g., bacteria, viruses)
Ergonomic Hazards (e.g., repetitive strain, workstation setup)
Psychosocial Hazards (e.g., stress, harassment)

How effective are current safety measures in your workplace?
Are employees provided with adequate safety training?
How frequently are workplace risk assessments conducted?
Please provide additional comments or suggestions regarding workplace safety and risk management.
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