Risk Assessment Supervisor Checklist Form
Use this form to systematically assess workplace risk conditions and required controls as a supervisor.
Date of Assessment
*
-
Month
-
Day
Year
Date
Supervisor Name
*
First Name
Last Name
Location/Area Being Assessed
*
Potential Hazards Identified (select all that apply)
*
Slips, trips, and falls
Manual handling/lifting
Hazardous substances
Machinery/equipment hazards
Electrical hazards
Fire risk
Other (please specify below)
Controls in Place (select all that apply)
*
Signage and warnings
Personal protective equipment (PPE)
Training provided
Barriers/guards installed
Regular maintenance
Other (please specify below)
Likelihood of Risk Occurrence
*
Rare
Unlikely
Possible
Likely
Almost certain
Severity of Potential Harm
*
Minor injury
Moderate injury
Serious injury
Major injury or fatality
Overall Risk Level
*
Low
Medium
High
Actions Required or Recommendations
Additional Comments
Submit Checklist
Should be Empty: