Child Activity Risk Assessment Form
Assess a child's participation in an activity by recording basic details, experience level, supervision needs, environmental risk factors, and the overall recommendation.
Child Details
Child's Full Name
*
First Name
Last Name
Child's Age
*
Planned Activity
*
Planned Activity Date and Time
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Risk Assessment Inputs
Previous Experience with Activity
*
No experience
Limited experience
Moderate experience
Experienced
Supervision Needs
*
Minimal supervision
1
2
3
4
5
6
7
8
9
Constant supervision
10
1 is Minimal supervision, 10 is Constant supervision
Known Safety Considerations
Needs close supervision
Tiredness
Weather sensitivity
Recent minor injury affecting participation
Other
Overall Perceived Risk Level
*
Please Select
Low
Medium
High
Assessment Summary
Assessor Name
*
First Name
Last Name
Role / Relationship to Child
*
Please Select
Parent/Guardian
Teacher
Coach
Caregiver
Relative
Other
Overall Risk Rating / Recommendation
*
Approved
Approved with Supervision
Needs Review
Not Recommended
Additional Notes
Submit Assessment
Should be Empty: