HSE Risk Assessment Form
Complete this form to identify, evaluate, and control health, safety, and environmental risks for your activity or workplace.
Assessor's Full Name
*
First Name
Last Name
Assessor's Email Address
*
example@example.com
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Assessment
*
Department / Project / Area
*
Description of Activity or Task Being Assessed
*
Hazard Identification and Risk Evaluation
*
Rows
Hazard Description
Potential Consequences
Likelihood (1-5)
Severity (1-5)
Risk Rating (Likelihood x Severity)
Existing Control Measures
Additional Controls Required
Responsible Person
Target Completion Date
Hazard 1
1
2
3
4
5
1
2
3
4
5
Hazard 2
1
2
3
4
5
1
2
3
4
5
Hazard 3
1
2
3
4
5
1
2
3
4
5
Overall Risk Level After Controls
*
Low
Medium
High
Are all identified risks adequately controlled?
*
Yes
No
Review Date (Next Assessment)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Comments or Observations
Assessor's Signature
*
Submit Assessment
Submit Assessment
Should be Empty: