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HSE Risk Assessment Template

Use this template to record an HSE Risk Assessment to control health and safety dangers either internally or externally in your workplace. Identify observed potential and existing dangers (e.g biological, chemical, energy, environment, etc.), evaluate the risk level (consequence, probability, and risk ratings), and implement necessary control measures. Monitor and examine planned control measures and recommend if further measures are needed. Lastly, implement overall recommendations to avoid and control risk hazards.
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Assessment
Hazard Identification
Describe the procedure, task or worksite being evaluated:
Biological (e.g. hygiene, disease, infection)
Are there biological dangers observed?
Chemicals
Are there chemical hazards observed?
Critical Incident
Are there critical dangers observed?
Energy Systems
Are there energy system dangers observed?
Add the hazards you have observed and identified:
Hazard
Kind of hazard/incident or issues involving:
Describe the hazard:
Attach a photo (optional):
Risk rating
Consequence:
Probability:
Risk rating:
Controls
Control measures
Environment
Are there environment risks observed?
Facilities / Built Environment
Are there facilities / built environment dangers observed?
Add a hazard after you have observed and identified it
Hazard
Kind of hazard:
Describe the hazard
Attach a photo of the hazard (optional):
Risk rating
Rate the consequence:
Probability:
Risk rating:
Controls
Control measures:
Machinery, Plant and Equipment
Are there any machinery, plant and equipment risks observed?
Manual Tasks / Ergonomics
Are there any manual tasks / ergonomics risks observed?
People
Are there people dangers observed?
Others
Are there any other hazards not listed above?
References
Hierarchy of Controls Reference:
Risk Matrix Reference:
Monitor and Review Controls
Have there been any modifications to the planned control measures?
Are the proposed control measures adequate and effective in reducing the level of risk?
Are further control measures necessary in future?
Completion
Further recommendations:
Name and signature of the inspector:
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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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