Document text
Risk assessment record
Business: [BUSINESS NAME]
Address of the workplace: [ADDRESS]
Activity or area assessed: [FOR EXAMPLE: OFFICE, SHOP FLOOR, KITCHEN, DELIVERIES]
Number of employees: [NUMBER]
Assessment carried out by: [NAME AND JOB TITLE]
Employees consulted: [NAMES OR TEAM]
Date of assessment: [DATE]
Date of next review: [DATE]
Significant findings
What are the hazards? Who might be harmed and how? What are you already doing to control the risks? What further action do you need to take? Who needs to carry out the action? When is the action needed by? Done
[HAZARD 1, E.G. SLIPS AND TRIPS] [WHO AND HOW] [CONTROLS IN PLACE] [FURTHER ACTION] [NAME] [DATE] [DATE DONE]
[HAZARD 2, E.G. MANUAL HANDLING] [WHO AND HOW] [CONTROLS IN PLACE] [FURTHER ACTION] [NAME] [DATE] [DATE DONE]
[HAZARD 3, E.G. WORK-RELATED STRESS] [WHO AND HOW] [CONTROLS IN PLACE] [FURTHER ACTION] [NAME] [DATE] [DATE DONE]
[HAZARD 4] [WHO AND HOW] [CONTROLS IN PLACE] [FURTHER ACTION] [NAME] [DATE] [DATE DONE]
Groups especially at risk
[FOR EXAMPLE: YOUNG WORKERS, NEW OR EXPECTANT MOTHERS, WORKERS WITH A DISABILITY, LONE WORKERS, VISITORS OR MEMBERS OF THE PUBLIC], and what we do for them: [MEASURES].
When we will review this assessment
We will review this assessment by [REVIEW DATE], and earlier if there is reason to think it is no longer valid, after an accident or near miss, or when staff, processes, substances or equipment change.
Sign-off
Name Date Signature
Assessed by [NAME] [DATE] ____________________
Approved by (manager or owner) [NAME] [DATE] ____________________
Employees informed
The risks and the controls above have been explained to staff on [DATE] by [NAME / TEAM BRIEFING / NOTICE BOARD / EMAIL].
Employee Date Read and understood
[NAME] [DATE] ____________________
[NAME] [DATE] ____________________
For me: before I file it
[ ] I looked at the actual workplace, not only an example (HSE)
[ ] Each hazard has who might be harmed and how, and what we do about it (HSE)
[ ] With 5 or more employees, the significant findings and any group especially at risk are recorded (MHSWR 1999, reg. 3(6))
[ ] If we employ anyone under 18, the assessment covers young persons before they start (reg. 3(4) and (5))
[ ] Staff have been told about the risks and the controls in a way they understand (reg. 10)
[ ] Review date set; review earlier if things change (reg. 3(3))