Power Risk Assessment Form

Power Risk Assessment Form
Use this form to assess electrical and power-related risks, system conditions, existing controls, and recommended corrective actions.
Site and Contact Details
Site Name
Assessment Location / Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Assessor Name
Assessment Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Power System Overview
System Type
Other
Voltage Level / Range
Equipment Area / Zone Assessed
Risk and Control Assessment
Identified Hazards
Other
Risk Severity
Likelihood
Existing Controls Effectiveness

1
2
3
4
5
6
7
8
9
10
1 is Ineffective, 10 is Highly effective
Recommended Corrective Actions
Should be Empty:

Select theme: