Executive Risk Assessment Intake Form
Use this Executive Risk Assessment Intake Form to provide essential information for evaluating executive risk context and urgency.
Executive Full Name
*
First Name
Last Name
Executive Title/Role
*
Organization
*
Business Email
*
example@example.com
Risk Assessment Matrix
*
Rows
Low
Moderate
High
Reputational Risk
1
2
3
Operational Risk
4
5
6
Compliance Risk
7
8
9
Strategic Risk
10
11
12
Urgency of Risk
*
Not Urgent
1
2
3
4
Extremely Urgent
5
1 is Not Urgent, 5 is Extremely Urgent
Estimated Potential Impact
*
Minimal (Little or no disruption)
Moderate (Manageable disruption)
Significant (Major disruption or loss)
Has this risk been previously identified?
*
Yes
No
Primary Risk Drivers (select all that apply)
*
Leadership Change
Market Factors
Regulatory Issues
Internal Controls
Other
Additional Context or Notes
Submit Assessment
Should be Empty: