Equipment Qualification Risk Assessment Form
Equipment Qualification Risk Assessment Form
Equipment Name or ID
*
Department or Location
*
Current Qualification Status
*
Qualified
Provisionally Qualified
Not Qualified
Operational Risk Level
*
1
2
3
4
5
Compliance with SOPs and Regulatory Requirements
*
Compliant
Minor Non-Compliance
Major Non-Compliance
Maintenance History Status
*
Up to Date
Due Soon
Overdue
Risk Assessment Matrix
*
Rows
Likelihood of Failure
Impact of Failure
Mechanical Failure
1
2
Electrical Failure
3
4
Control System Failure
5
6
Mitigation Measures in Place
*
Preventive Maintenance
Operator Training
Redundancy/Backup
Alarm/Monitoring Systems
Other
Overall Equipment Readiness Rating
*
1
2
3
4
5
Assessor's Name
*
First Name
Last Name
Additional Comments or Observations
Submit Assessment
Should be Empty: