Youngman - Risk Assessment Form

Risk Assessment Form

Please refer to both pages of the Risk Assessment Form by following this link BEFORE completing the form below and then press the submit button. You can also follow this link to print or download a copy of our Risk Assessment Form if you do not wish to use the interactive form below.

Ref No *

Date *

Time *

Site & location *

Assessment carried out by *

Main activity *

Notes

Activity 1

Activity Undertaken - list tools / materials needed that may make working hazardous. *

Estimated working height (m) *

Estimated working time (hrs) *

Hazards identified - consider proximity of electricity, chemicals, sharp edges, ground conditions [level / slope / state of ground], wind etc. *

Person at risk *

Injury severity *

Injury probability * Risk level too high, please add control measures and re-assess belowRisk level acceptable, you’re safe to continue to next activity or to submit this form

Control measures - take action through your choice of access equipment and other measures to control and lessen the risk.

New injury severity

New injury probability Risk level too high, please add further control measures and re-assessRisk level acceptable, you’re safe to continue to next activity or to submit this form

Action by *

Activity 2

Activity Undertaken - list tools / materials needed that may make working hazardous.

Estimated working height (m)

Estimated working time (hrs)

Hazards identified - consider proximity of electricity, chemicals, sharp edges, ground conditions [level / slope / state of ground], wind etc.

Person at risk

Injury severity

Injury probability Risk level too high, please add control measures and re-assess belowRisk level acceptable, you’re safe to continue to next activity or to submit this form

Control measures - take action through your choice of access equipment and other measures to control and lessen the risk.

New injury severity

New injury probability Risk level too high, please add further control measures and re-assessRisk level acceptable, you’re safe to continue to next activity or to submit this form

Action by

Activity 3

Activity Undertaken - list tools / materials needed that may make working hazardous.

Estimated working height (m)

Estimated working time (hrs)

Hazards identified - consider proximity of electricity, chemicals, sharp edges, ground conditions [level / slope / state of ground], wind etc.

Person at risk

Injury severity

Injury probability Risk level too high, please add control measures and re-assess belowRisk level acceptable, you’re safe to continue to next activity or to submit this form

Control measures - take action through your choice of access equipment and other measures to control and lessen the risk.

New injury severity

New injury probability Risk level too high, please add further control measures and re-assessRisk level acceptable, you’re safe to continue to next activity or to submit this form

Action by

Activity 4

Activity Undertaken - list tools / materials needed that may make working hazardous.

Estimated working height (m)

Estimated working time (hrs)

Hazards identified - consider proximity of electricity, chemicals, sharp edges, ground conditions [level / slope / state of ground], wind etc.

Person at risk

Injury severity

Injury probability Risk level too high, please add control measures and re-assess belowRisk level acceptable, you’re safe to continue to next activity or to submit this form

Control measures - take action through your choice of access equipment and other measures to control and lessen the risk.

New injury severity

New injury probability Risk level too high, please add further control measures and re-assessRisk level acceptable, you’re safe to continue to next activity or to submit this form

Action by

Activity 5

Activity Undertaken - list tools / materials needed that may make working hazardous.

Estimated working height (m)

Estimated working time (hrs)

Hazards identified - consider proximity of electricity, chemicals, sharp edges, ground conditions [level / slope / state of ground], wind etc.

Person at risk

Injury severity

Injury probability Risk level too high, please add control measures and re-assess belowRisk level acceptable, you’re safe to continue to next activity or to submit this form

Control measures - take action through your choice of access equipment and other measures to control and lessen the risk.

New injury severity

New injury probability Risk level too high, please add further control measures and re-assessRisk level acceptable, you’re safe to continue to next activity or to submit this form

Action by

The Youngman Interactive Risk Assessment Form is designed as a tool to assist with the completion of a Risk Assesment and provide you with a copy to print (in landscape format) and retain for your records.

Youngman Group Limited accepts no liability for any incident, accident or loss caused by the use of this form. Please tick the box to confirm that you have understood and accepted this condition before proceeding.

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Risk Assessment Form

Activity 1

Activity 2

Activity 3

Activity 4

Activity 5