ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
2
3
Project Name
Project Reference #
4
Site NameSite Location Address
5
AssessorAssessed OnReview On
6
7
Main ActivityTaskHazardsRiskEffected PeopleRisk Rating ScoreControl MeausuresResidual Risk Rating
8
LikelihoodSeverity
Risk Rating
9
10
11
12
13
14
15
16
17
18
19
20
Likelihood SeverityLikelihoodFrequencyLikelihood
21
Insignificant (1)Minor (2)Moderate (3)Major (4)Catastrophic (5)EnvironmentHealth and Safety
22
Rare (1)12345FrequentContinuous or happens againOccurs frequently5
23
Possible (2)246810Often5-12 times per yearOccurs several times a year4
24
Likely (3)3691215Likely1-5 times per yearHas occurred more than once3
25
Often (4)48121620PossibleOnce every 5 yearHas occurred2
26
Frequent (5)510152025RareLess than once every 5 yearNever occurred1
27
Risk Risk Level Action
28
15-25Extreme riskActivity or industry should not proceed in current form
29
8-DecHigh riskActivity or industry should be modified to include remedial planning and collection and be subject to detailed EHS assessment
30
4-JunModerate riskActivity or industry can operate subject management and/ or modification
31
1-MarLow riskNo action required. unless escalation of risk possible
32
33
34
35
36
37
38
39
40
41
42
Prepared ByApproved ByStamp
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100