Automatic Door Risk Assessment Form
Use this form to evaluate safety risks, identify hazards, and document recommended actions for an automatic door.
Site and Door Identification
Site/Building Name
*
Door Location/Area
*
Automatic Door Type
*
Sliding
Swinging
Revolving
Folding
Other
Risk Assessment Details
Pedestrian Traffic
*
Low
1
2
High
3
1 is Low, 3 is High
Door Closing Speed
*
Slow
1
2
Fast
3
1 is Slow, 3 is Fast
Risk Factors Assessment
*
Rows
Low
Moderate
High
Obstruction Risk
1
2
3
Sensor Performance
4
5
6
Pinch/Crush Hazard
7
8
9
Emergency Egress Impact
10
11
12
Maintenance Condition
13
14
15
Overall Risk Level
*
Low
1
2
Critical
3
1 is Low, 3 is Critical
Inspection Outcome and Actions
Overall Risk Level
*
Low
Medium
High
Critical
Corrective Actions / Recommendations
*
Target Completion / Follow-up Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
Should be Empty: