This risk assessment form evaluates potential hazards for an activity taking place on Severn Road. It identifies hazards such as being hit by a car while working on the road, tripping over bags or loose bricks, and fire from overused computers. Existing controls are noted, such as keeping bags out of the way and computer fans preventing overheating. Additional actions recommended include not working in the road, securing loose bricks, and turning off overheating computers. The form provides a risk rating matrix to evaluate risk levels and determine appropriate actions.

1. RISK ASSESSMENT RECORDING FORM
Location or
Address: Severn Road
Date Assessment
Undertaken:17th
December 2016
Assessment undertaken
By:
Activity or
Situation: On the pavement
Review
Date:
Signature
(1) Hazard Risk (2) Who might be harmed and how? (3) What controls exist to reduce
risk
(4) What action can be taken
to further reduce risk?
Hit by car
Bags
Fall over drive
Bags
Fire
4
1
1
2
3
Model or crew could be hit by a car
as it is on the street
People could fall over the equipment
bags or college backpacks
Could trip over something on the
floor or a loose brick etc
People in the room could trip over
bags and hurt themselves.
If the computer is overused it could
catch fire and hurt a student or
teacher badly.
We do not intend to work on the
road what so ever
If we do, we will be very careful
and ensure there are no cars
coming
We will keep the bags out of the
way of which that we will be
working
The bricks are stable and will clear
everything in the way
Bags are kept out of harm’s way
under the desk.
There are fans within the
computers of which keep this from
happening successfully.
Just do not go in the road what so
ever and stay on pavement
Put all bags in my house so
cannot be fell over
Ensure that those working on the
drive are very careful and not
distracted
Always keep bags under the
desks when not being used.
If the computer becomes very hot,
the fan will either stop this from
happening or the computer should
be turned off

2. 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
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
risk
(5) What action can be taken
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