RISK ASSESSMENT RECORDING FORM
Location or Date Assessment
Address: House, 59 Barley road WA42EZ Undertaken:
Activity or Review
Situation taking images for magazine Date:
(1) Hazard Risk (2) Who might be harmed and how?
1) Chairs that people can trip on and 1 The person that has fallen over the
hurt the leg. chair would be the most likely
affected one.
2) People may stub their toe on the 1 The person that has stubbed their
side of the table or walk into it toe may feel the pain for a while
after.
3) Electraction from wires that are 4 Those who are using the equipment
near or from any plug sockets. would be harmed in the event of
this.
4) Door hitting someone 2 If room is small the door could be
heavy and wake someone in the
face.
5) sharp edges on counters 2 people cound cut their hand or
injure their side if the walk into it.
1. List hazards something with the potential to cause harm here:
Seek to quantify the level of risk the likelihood of harm arising based on the number of persons affected, how often they are exposed to the hazard and the
severity of any consequence.
2. List groups of people who are especially at risk from the significant hazards which you have identified
Assessment undertaken
By: Yasmin Dean
Signature
(3) What controls exist to reduce
risk
Make sure to tell people not to walk
closely to the chairs as it may
cause an injury.
Warn people that the table stands
out from the wall so be careful not
to stub a toe or fall over it.
To reduce the risk of this
happening we will check to make
sure all wires have their casings
intact.
Look through the window on the
door to make sure no one is
coming.
tell people not to walk too close to
the counters.
(4) What action can be taken
to further reduce risk?
Move the chairs to a space that
won't harm anyone.
Don't take the photos near the
table so that people don't get hurt
or move it so that people won't
walk into it.
Further action could include
checking all electrical equipment
prior to recording, to try and find
any faults or dangers with the
equipment.
Don't sit too close to the door so
that when people come in and out
they won't wake anyone.
don't take the images to close to
the counter.
 3. List existing controls here or note where the information may be found
4. List the risks which are not adequately controlled and the action you will take. Have regard for the level of risk, the cost of any action and the benefit you expect to
gain.

(1) Hazard Risk (2) Who might be harmed and how? (3) What controls exist to reduce (5) What action can be taken
risk to further reduce risk?

RISK RATING

a SEVERITY b LIKELIHOOD c FINAL SCORE RATING: what needs to be done

5 Dying or being permanently disabled 5 Will almost certainly happen 16-25 Stop! Do not start activity again until risk is
controlled
4 Serious injury/long term illness 4 Highly likely to happen 10-15 High risk level, High priority. Take action
straight away to control the risk
3 Temporary disability/3 days off sick 3 Not so likely 6-9 Medium risk level. Tighten up controls and
make a plan to do something about risk
2 Will need medical attention 2 Even less likely 3-5 Fairly low risk level. Low priority but keep
possible action in mind
1 Minor injury eg. Bruise, graze 1 Unlikely to happen at all 1-2 Low or trivial risk. No further action
required.

SO: a x b = c

Action Required Responsible Person Date for Completion