Activity Risk Assessment
Evaluate and document the risks associated with your planned activity.
Assessor's Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Activity Title
*
Location of Activity
*
Describe the purpose and main steps of the activity
*
Identify Hazards and Assess Risks
*
Rows
Hazard Description
Persons at Risk
Likelihood (1-Low, 5-High)
Severity (1-Minor, 5-Severe)
Existing Controls
Risk Rating
Hazard 1
Hazard 2
Hazard 3
Overall Risk Level After Controls
*
Low
Medium
High
Recommended Additional Control Measures
Person(s) Responsible for Implementing Controls
Review Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor's Signature
*
Submit Assessment
Submit Assessment
Should be Empty: