Risk Assessment Data Collection Form
Please complete the Risk Assessment Data Collection Form to provide detailed information for evaluating and managing potential risks.
Assessment Title
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
First Name
Last Name
Area or Process Being Assessed
*
Risk Category
*
Please Select
Safety
Financial
Operational
Reputational
Compliance
Environmental
Other
Describe the Risk
*
Likelihood of Risk Occurrence
*
Rare
Unlikely
Possible
Likely
Almost Certain
Potential Impact if Risk Occurs
*
Insignificant
Minor
Moderate
Major
Severe
Current Controls in Place
Risk Rating Matrix
*
Rows
Likelihood
Impact
Low
1
2
Medium
3
4
High
5
6
Submit Assessment
Should be Empty: