Equipment Maintenance Risk Assessment Form
Evaluate and document potential risks associated with equipment maintenance activities to ensure workplace safety and compliance.
Equipment Information
Provide basic details about the equipment to be assessed.
Equipment Name/ID
*
Location of Equipment
*
Type of Maintenance Activity
*
Please Select
Preventive Maintenance
Corrective Maintenance
Routine Inspection
Emergency Repair
Other
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Maintenance Performed By (Name/Team)
*
Hazards and Risk Evaluation
*
Rows
Hazard Identified
Likelihood (1-Low, 5-High)
Severity (1-Minor, 5-Catastrophic)
Existing Controls
Further Action Required?
Hazard 1
1
2
3
4
5
1
2
3
4
5
Yes
No
Hazard 2
1
2
3
4
5
1
2
3
4
5
Yes
No
Hazard 3
1
2
3
4
5
1
2
3
4
5
Yes
No
Overall Risk Rating for This Maintenance Activity
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Are additional control measures recommended?
*
Yes
No
If yes, please describe recommended additional controls
Person Responsible for Implementing Controls
Additional Comments or Observations
Submit Assessment
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