MBC - RISK ASSESSMENT FORM

MBC - RISK ASSESSMENT FORM

Activity Name and Description: *

Activity Location: *

Activity Date/s: *

Ministry/Dept Responsible: *

Person/s Responsible: *

Assessors: *

Assessment Date: *

TASKS: List each of the tasks for the activity

HAZARDS/RISKS: List the hazards / risks associated with each task

LIKELIHOOD: (L1-L5)

CONSEQUENCES: (C1-C5)

RISK RATING: (L/M/H)

RISK CONTROL MEASURES: Nominate Control Measures

RESPONSIBILITY: Nominate the Person Responsible

TASK 1:

Hazards/Risk:

Likelihood:

Consequences:

Risk Rating:

Risk Control Measures:

Responsibility:

TASK 2:

Hazards/Risk:

Likelihood:

Consequences:

Risk Rating:

Risk Control Measures:

Responsibility: