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Hazard Analysis and Risk Assessment Form

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Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates
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Digitalize this paper form now

Register for free on lumiformapp.com and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 5/5 stars on Capterra
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Hazard Analysis and Risk Assessment Form

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