Occupational Exposure Risk Assessment Form
Employee Information
Name
Employee ID
Department/Unit
Job Title
Assessment Date
Exposure Details
Type of Hazard
Description of Exposure
Route of Exposure
Inhalation
Skin
Ingestion
Injection
Other
Exposure Duration (hours)
Exposure Frequency
One-time
Occasional
Frequent
Daily
Risk Evaluation
Risk Level
Low
Medium
High
Contributing Risk Factors
Existing Controls
Recommended Additional Measures
Assessment Review
Assessor Name
Assessor Title
Date of Review
Signature