Dynamic Risk Assessment Checklist
Complete this checklist to identify and evaluate risks for your activity, workplace, or site.
Assessor Full Name
*
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Assessment
*
Activity or Task Being Assessed
*
Hazard Identification Table
*
Rows
Hazard Description
Persons at Risk
Existing Controls
Hazard 1
Hazard 2
Hazard 3
Risk Likelihood (How likely is the hazard to occur?)
*
Very Unlikely
1
2
3
4
Very Likely
5
1 is Very Unlikely, 5 is Very Likely
Risk Severity (What is the potential impact?)
*
Insignificant
1
2
3
4
Catastrophic
5
1 is Insignificant, 5 is Catastrophic
Current Overall Risk Rating
*
Low
Medium
High
Are additional controls required?
*
Yes
No
If yes, describe the additional control measures needed
Person Responsible for Implementing Controls
Target Date for Implementation
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final Risk Rating After Controls
Low
Medium
High
Comments or Observations
Submit Assessment
Should be Empty: