Workstation Risk Assessment Form
Organization & Assessor Information
Nonprofit Organization Name
Location / Workstation
Employee Name
Assessor Name
Date of Assessment
Workstation Details
Type of Work Performed
Workstation Equipment (list)
Risk Assessment
Hazard/Issue
Potential Harm
Likelihood
(Low/Med/High)
Severity
(Low/Med/High)
Controls/Actions
Additional Notes
Employee Comments
Assessor Signature
Name
Date