Multi-Hazard Risk Assessment Checklist Form
Use this Multi-Hazard Risk Assessment Checklist Form to systematically assess site hazards and identify existing or recommended controls.
Site Location
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Select all hazards present at the site
*
Slips, trips, and falls
Manual handling
Hazardous substances
Working at height
Electrical hazards
Machinery and equipment
Fire hazards
Noise exposure
Confined spaces
Other
Overall site risk level
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Are control measures in place for all identified hazards?
*
Yes, all controls in place
Some controls in place
No controls in place
Select additional controls recommended
Signage and warnings
Personal protective equipment (PPE)
Training and supervision
Engineering controls
Administrative controls
Other
Rate the adequacy of existing controls
*
1
2
3
4
5
Have all actions been assigned to responsible persons?
*
Yes
No
Comments or observations
Submit Assessment
Should be Empty: