Occupational Safety and Health Division

18 Havelock Road #03-02

Singapore 059764
Tel: 64385122
www.mom.gov.sg
mom_oshd@mom.gov.sg

Activity-based Risk Assessment Form

This form may take you 30 minutes to complete.

You will need the following information to fill in the form:

• Process Flow Chart

 RISK ASSESSMENT FORM
ACTIVITY-BASED RISK ASSESSMENT

INVENTORY OF WORK ACTIVITIES

Company:
No. Process/Location Work Activities

Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment
 RISK ASSESSMENT FORM
ACTIVITY-BASED RISK ASSESSMENT FORM
Company: Conducted by:
Process/ Location: (Names, designations)
Approved by: (Date)
(Name, designation)
Last Review Date: Next Review Date:
(Date)

1. Hazard Identification 2. Risk Evaluation 3. Risk Control

1a. 1b. 1c. 1d. 2a. 2b. 2c. 2d. 3a. 3b.
Possible Accident / Existing Risk Action Officer,
Control Sev- Likeli- Risk Additional Designation
No. Work Activity Hazard Ill Health &
erity hood Level Risk Control
Persons-at-Risk (if any) (Follow-up date)

Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment