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Hazard Analysis and Risk Assessment Form

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Audit
Task
Position/Occupation
Company
Location
Supervisor Name and Title
Worker(s) Name and Title
Frequency Rating (3-Daily/Frequently, 2-Monthly/Occasionally, 1-Quarterly/Rarely) Severity Rating (3-Fatality/Catastrophic Property Damage, 2-Lost Time Injury/Major Property Damage, 1-Medical Aid/Minor Property Damage) Probability Rating (3-Reasonably Probable, 2-Remote, 1-Extremely Remote)
Task Analysed
Task Analysis
Task Steps-Activities
Photo Support
Existing or Potential Hazards
Health and/or Safety
Frequency
Severity
Probability
Priority Rating
Current Hazard Control
Hazard Control Required or Improvement Recommended
Department Involved in Implementation
Assigned to
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.
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