Hygiene Risk Assessment Form
Identify and evaluate hygiene risks, existing controls, and corrective actions.
Assessor name
*
Assessment date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Site or area assessed
*
Activity or process assessed
*
Hygiene hazard categories
*
Cleaning and disinfection
Hand hygiene
Cross-contamination
Waste handling
Pest control
Storage
Other hygiene hazard
Hazard description and potential impact
*
Likelihood of occurrence
*
Rare — unlikely to occur
Unlikely — could occur, but not expected
Possible — may occur sometimes
Likely — expected to occur in many circumstances
Almost certain — expected to occur frequently
Severity of impact
*
Negligible — minimal impact
Minor — limited impact requiring routine attention
Moderate — meaningful impact requiring corrective action
Major — serious impact requiring prompt action
Critical — severe impact requiring immediate action
Current controls and their effectiveness
*
Recommended corrective actions, responsible role, and target completion date
*
Submit Assessment
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