Hazardous Materials Transportation Risk Assessment Form
1. Shipment Information
Date
Shipper Name
Receiver Name
Material Description
UN Number
Quantity
Package Type
Mode of Transport
Road
Rail
Air
Sea
2. Route Information
Origin
Destination
Route Description
3. Risk Assessment
Potential Hazards
Likelihood of Incident
Low
Medium
High
Impact Severity
Minor
Moderate
Severe
Control Measures/Precautions
4. Assessment Summary
Summary & Recommendations
Assessor Name
Assessment Date