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Page
1

of
5


This form
should
be retained for 6
years




RISK ASSESSMENT

Assessment No:


Company Name


Date Prepared


Address






Review Date


Programme title





Name of
Network



Date of
Transmission


Tel



Work Acti
vity
Being Assessed


Describe in more detail where this
activity takes place:



Manager’s Declaration (Not to be Signed Off until Risk Assessment is Completed)



Signature of Assessor ....................................................................
....


Name (printed) ...........................................
..............................
.........


Date ………………….


Position in Company

......................................................................... Tel/email ...............
...............................................


*

M
ANAGER SHOULD NOW DE
LETE AS APPROPRIATE
AND SIGN THE FORM


*

ACCEPTANCE:

I

a m s a t i s f i e d t h a t t h e a c t i v i t y ma y c o n t i n u e


*

A N A C T I ON P L A N
:
i s a t t a c h e d a t S t e p 3


* P ROHI B
I T I ON:

I a m
n o t

s a t i s f i e d t h a t t h e
r i s k ( s ) i d e n t i f i e d a r e a c c e p t a b l e

w i t h o u t a d d i t i o n a l c o n t r o l
me a s u r e s b e i n g i n p l a c e. I h a v e t h e r e f o r e t a k e n a c t i o n t o p r e v e n t t h e a c t i v i t y c o n t i n u i n g.




S i g n a t u r e o f Ma n a g e r ...........................................
.............................


N a me ( p r i n t e d ) ....................................................
..............................



D a t e …………………


P o s i t i o n i n C o mp a n y

......................................................................... T e l
/e ma i l ..............................................................




Page
2

of
5





RISK ASSESSMENT

Assessment No:





more detailed assessment may be required for hazards shown in bold



Groups Particularly at Risk:

The presence of any of the following groups may affect the level of risk (due to vulnerability, lac
k of
knowledge etc) associated with the hazards you have identified above. Extra safety controls may be
necessary. Indicate all the groups relevant to this risk assessment.

Children (under 18) need for supervision and child
protection, unauthorised acc
ess)



Individuals with disabilities or medical conditions


Pregnant Women and Nursing Mothers



Members of the Public


New Employees



Other (please specify)


Inexperienced Workers









STEP 1



How can people get hurt? Use this list as a check and tick the box where it

applies. A
dd
other
items, unique to your work area, if necessary. Step back and consider any other Hazards!
Involve the managers, staff and where necessary the safety professionals, in deciding what is to be
included.

HAZARDS

1. Access/Egress
(Obst
ructions?)


12. Food Hygiene



23. Slipping, Tripping, Falling


How Else Can People
Get Hurt (specify below)

2. Animals


13. Hand Tools



24. Storage (racks, shelves etc)



3. Asbestos


14.

Hazardous Substances
(CoSHH)



25. Transport (forklift trucks,
v
ehicles, tractors etc)




4. Audience Control


15. Heights (inc ladders,
scaffolding)




26. Violence (attack and public
disorder)



5. Compressed
Gas/Cryogenics (Storage &
Use)


16. Lifting Equipment



27. Weather (hot/cold/lightening
etc)



6. Confine
d Spaces


17. Lone Working



28.
Working Environment

(inc
Temporary Workplaces)



7. Construction Work


18.

Manual Handling



29. Working Patterns / Work
organisation



8.

Display Screen
Equipment (DSE)


19.

Noise Exposure
-

( E q u i p me n t/Mu s i c/
He a d p h o n e s
)


3 0. Wo r k s h o p E q u i p me n t



9. E l e c t r i c i t y ( i n c p o r t a b l e
a p p l i a n c e s )


2 0. O f f i c e E q u i p me n t


3 1. O t h e r H a z a r d s


e g p h y s i c a l
e x e r t i o n, w o r k n e a r w a t e r e t c



1 0. F i r e ( b u i l d i n g f i r e s a f e t y )


2 1. P r e s s u r e S y s t e ms





1 1. F l a mma b l e Ma t e r i a l s



2 2. R a d i a t i o n

( R F,
Mi c r o w a v e e t c )

R a d i a t i o n ( r a d i o
-
a c t i v e
s o u r c e s )





Page
3

of
5





RISK ASSESSMENT

Assessment No:



STEP 2


Transfer the details of the hazards identified in Step 1.

Now assess the risks from the hazards identified on the previous page by completing the
form below.
(Copy this page as many times as necessary to assess all of the hazard
s
)


What could
cause HARM?

(List here the
things you
have noted

on the
previous page)

WHO might be
Harmed and HOW?

(Always give
particular
consideration to

people with special
needs)

EXISTING CONTROL
MEASURES

What do you do already to
stop these people
getting
hurt?

Existing Risk
*

High/Medium/

Low

(See Table 1
to help you)

FURTHER
ACTIONS
REQUIRED


(Yes/No)














































































































































Page
4

of
5





RISK ASSESSMENT

Assessment No:




STEP 3


ACTION PLAN
-

Transfer the details of the hazards requiring further action, as
identified in Step 2.

Now complete the Action Plan form below.


What
FURTHER
ACTIONS are
required to
reduce the
risks to the
lowest level
reasonably
practicable?

(Particularly
for High or
Medium risks)

WHO is
RESPONSIBLE
for
ensuring these
further actions
are carried out?

WHEN are
these further
actions
re
quired to be
completed?


SIGN
-
OFF when further
actions are completed

Are there any other
actions now required?

(
Does the Risk
Assessment need to be
reviewed?)































































































































Page
5

of
5






RISK ASSESSMENT

Assessment No:


Table 1

Classification of Risk

Risk Analysis/Priority of Action Matrix


SEVERITY

LIKELIHOOD


1

Very Unlikely

(
freak even


no known
history)

2

Unli
kely

(Unlikely sequence of
events)

3

Possible

(Foreseeable under
unusual circumstances)

4

Likely

(Easily foreseeable
-

o d d i n c i d e n t m a y h a v e
o c c u r r e d )

5

Ve r y Li ke l y

( C o m m o n o c c u r r e n c e


a w a r e o f i n c i d e n t s )

1

Ne g l i g i b l e

( N o v i s i b l e i n j u r y


n o
p a i n )

Lo w

Lo
w

Low

Low

Low

2

Slight

(Minor cuts, bruises


no
long term effects)

Low

Low

Low

Medium

Medium

3

Moderate

(Heavy bruising, deep
flesh wound. Lost time
accident)

Low

Low

Medium

High

High

4

Severe

(Lost time accidents and
major injuries)

Low

Medium

High

H
igh

High

5

Very Severe

(Long term disability or
death)

Low

Medium

High

High

High


Ensure that the significant findings of the risk assessment are communicated to all people at work who
may be affected by the activities