RISK ASSESSMENT

V9

ACTIVITY

HAZARD

RISK
H/M/L

PRECAUTIONS

IN
PLACE

Vehicles on the road

Could get run over

Watch where you are walking

and always look both ways
before you cross the roads

River

You could fall in river

Watch where you are walking

REVIEW
DATE

17/11/1
6

REVIEWER

AJON

AJON
17/11/1
6

Dog walkers

Disturbance/in the way of

other people

Be aware of your surroundings

AJON
17/11/1
6

Please leave this section blank:

Risk Assessment checked by: Name ..
KEY:

Activity :
Hazard :
Risk:
Precautions:
In Place:

Signed .

Date

Describe the component part of your pursuit.

List the things you anticipate might cause harm or the things associated with your activity that have the potential to cause harm. Consider the likely
harm.
Assess the risk as either H (High), M (Medium) or L (Low). When concluding your assessment consider all of the circumstances.
Consider what you could do to minimise / negate the risk.
Will the precautionary measures be in place at the time of the activity?

Review Date:
Reviewer:
V9/PALL/sspi/reviewedOct2010

When would it be reasonable to review your assessment? Remember it might be whilst you are undertaking the activity.
Name of the person responsible for completing the risk assessment.
A copy of this form should be taken on the activity or visit by the Reviewer.