This blank risk assessment form follows the CRGI Solutions HSQEMS format. Complete the site information section, then identify each hazard in Part 1a, score using the 5×5 matrix (Severity × Likelihood = Risk), apply controls, and re-score. All personnel briefed on this assessment must sign Part 1b. Use the Excel version for editable working copies. Refer to HPROC01 (Risk Assessment Procedure) and HPOL05 (Risk Assessment Policy) for guidance.
Assessment Details
Assessment Title
Reference Number
Location / Site
Activity / Process
Assessor Name
Assessment Date
Review Date
Approved By
Part 1a — Risk Assessment
#
Activity / Process
Foreseeable Hazard
Who / What Affected
Existing Controls
S
L
R
Exposure
New Controls & Further Action
S
L
R
Exposure
1
2
3
4
5
6
7
8
9
10
Risk Scoring Matrix — Severity × Likelihood
Likelihood ↓ / Severity →
1 Negligible
2 Minor
3 Moderate
4 Major
5 Catastrophic
5 Almost Certain
5
10
15
20
25
4 Likely
4
8
12
16
20
3 Possible
3
6
9
12
15
2 Unlikely
2
4
6
8
10
1 Rare
1
2
3
4
5
Very Low (1–3) Low (4–6) Moderate (7–12) High (13–16) Very High (17–25)
Part 1b — Briefing Record
Briefing Requirement
By signing below, I acknowledge that I have received a health and safety briefing on the topic(s) covered by this risk assessment. If the risk assessment is updated, the briefing of the changes must be recorded as a new entry.