Low-Risk Assessment Form
Please complete this form to help us evaluate and document low-risk factors for your activity, environment, or process.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Assessment Context
*
Please Select
Workplace Environment
Home Environment
Public Event
Outdoor Activity
Other
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate the following risk factors for this context:
*
Rows
Very Low
Low
Moderate
High
Physical Hazards
1
2
3
4
Environmental Hazards
5
6
7
8
Equipment Safety
9
10
11
12
Procedural Risks
13
14
15
16
Emergency Preparedness
17
18
19
20
How likely is it that an incident could occur in this context?
*
Very Unlikely
Unlikely
Possible
Likely
Very Likely
How severe would the impact be if an incident did occur?
*
Negligible
Minor
Moderate
Significant
Severe
What current controls or precautions are in place?
Safety Training Provided
Protective Equipment Available
Clear Signage/Instructions
Supervision Present
Other
Overall risk rating for this context
*
1
2
3
4
5
Recommendations or additional comments
Submit Assessment
Should be Empty: