Cleaning Risk Assessment Form
Evaluate cleaning-related hazards and controls to ensure a safe and effective environment.
Assessment Location
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
First Name
Last Name
Description of Cleaning Activity
*
Identified Hazards
*
Risk Level
*
Low
Medium
High
Existing Controls in Place
*
Further Actions Required
Person Responsible for Actions
Target Completion Date for Actions
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
Should be Empty: