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General Information
Site/Location Name
Department/Team
Assessor Name
Assessment Date
Hazard Identification
Identify all potential hazards in the work area
Who could be harmed and how?
Risk Evaluation
What is the likelihood of harm occurring?
What is the potential severity of harm?
What is the overall risk rating?
Control Measures
Describe existing control measures
Are the control measures adequate?
What additional controls are required?
Action Plan
Action required
Person responsible
Target completion date
Action status