Example Risk Assessment Form
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1
2
3Likelihood
x
Severity
EXAMPLE RISK ASSESSMENT FORM
Very Unlikely
1
Minor injury, No time off
Unlikely
2
Injury and up to three days off
Likely
3
Reportable Condition
TASK/ACTIVITY
VENUE/ROOM/
Jubilee Square
Very Likely
4
Major injury/Long term absence
AREA
Certain
5
Death
DATE
REVIEW DATE
Select the Likelihood and multiply by selected Severity to give the
Risk Rating.
ASSESSOR
SIGNATURE
Risk Rating
High =16-25, Medium = 9-15, Low = 1-8
DESCRIPTION
CONSEQUENCE
PERSONS
CURRENT
RISK
OF HAZARD
OF HAZARD
AT RISK
CONTROL MEASURES
L X S =
H,M,OR L
1.
Vehicle movement on site, risk of
Broken bones
Staff,
Vehicle to be guided by stewards in high res
2x4=8 Low
collision with person or object
Death
Performers
jackets.
Public
Vehicle to not exceed 5mph.
Hazard lights to be turned on whilst moving.
Any vehicles remaining on the Square to have
a drip tray underneath
2x3=Low
2.
Construction / Dismantling of
Sprains, broken
Staff,
Staff experienced in handling equipment.
staging, risk of falling objects,
bones, back
Performers
Staff to look for potential hazards and report
collapsing structure, slips and trips,
strain
Public
them to the production manager
All electrical equipment will be checked for damage,
3.
Electricity / PA / DJ equipment, risk
Burns, sprains,
Staff
2x4=Low
abrasion before use.
of fire / electrocution, slips and trips
death
Performers
Cables routed away from pedestrian /vehicle routes
from leads
Public
Cables to be covered to reduce risk of slipping
Event will be cancelled if it rains
All equipment PAT tested
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Parent category: Business