Hazard identification and risk analysis checklist
Corporate safety & risk office - july 2014
What does this form include?
This form contains 30 sections:
Please add hazardous event
Event
Part 1(A) Associated Hazardous Events:
Additional Supporting Information
Participants
Staff Number
Name
Hazardous Event
Describe Event
Part 2 Hazard Safeguards
- Risk Index = Likelihood x Severity
Existing Safeguards
Safeguard
Document Reference
Describe the Solution when applicable:
Action Item
Safeguards Improvement Detail
Person Responsible for Completing Action
Agreed Target Date Date
Date Action Form Sent Date
Completion Date Date
Signature
Date Date
Part 4 Action Form
From (Assessor):
To (Department Manager):
The following suggested procedure improvement has been identified during a recent risk analysis to reduce the risk associated with:
Procedure Improvement Detail:
Target Date Date
Department Manager's Response:
Use this template