Restaurant Kitchen Risk Assessment Form
Use this form to assess kitchen hazards, record current controls, and document corrective actions for a restaurant kitchen.
Kitchen Context
Kitchen Location or Station
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift or Service Period
*
Breakfast
Lunch
Dinner
Prep
Closing
Other
Assessor Name or Role
*
Risk Assessment
Primary hazard category
*
Slips/trips/falls
Cuts
Burns/scalds
Fire
Food contamination
Equipment malfunction
Chemical exposure
Manual handling
Pest/cleanliness issue
Other
Risk severity
*
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
Risk likelihood
*
Unlikely
1
2
3
4
5
6
7
8
9
Likely
10
1 is Unlikely, 10 is Likely
Current control measures in place
Immediate corrective actions required
*
Review and Follow-Up
Follow-up Owner or Responsible Team Member
*
Target Completion Date for Corrective Actions
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Final Notes or Additional Observations
Submit
Should be Empty: