Workplace Health Risk Assessment Form
Assessor Name
Date
Department/Area
Location
Hazard Identification
Describe the identified health hazards
Persons at Risk
List persons or groups at risk (e.g. employees, contractors, visitors)
Current Control Measures
Detail existing control measures in place
Likelihood of Harm
Rare
Unlikely
Possible
Likely
Very Likely
Severity of Harm
Minor
Moderate
Serious
Major
Catastrophic
Risk Level & Further Action
Estimated risk level (after existing controls)
Further action required
Responsible Person & Review
Responsible Person
Review Date