Hazard Analysis and Risk Assessment Questionnaire Form
Complete this assessment to identify hazards and evaluate associated risks. All responses are required for a comprehensive analysis.
Assessment Title or Reference
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Department or Area Being Assessed
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Describe the process, activity, or location being analyzed
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Select the type of hazard most relevant to this assessment
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Physical
Chemical
Biological
Ergonomic
Psychosocial
Other
How would you rate the likelihood of the identified hazard occurring?
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1
2
3
4
5
How severe could the consequences be if the hazard occurs?
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1
2
3
4
5
What controls or preventive measures are currently in place?
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How effective are the existing controls?
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Highly effective
Moderately effective
Slightly effective
Not effective
Risk Matrix: Rate each hazard for likelihood and severity
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Rows
Likelihood (1-5)
Severity (1-5)
Hazard 1
Hazard 2
Hazard 3
Additional comments or recommendations
Submit Assessment
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