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V9                                                                         RISK ASSESSMENT

                                                                                     RISK                                                           IN         REVIEW
                  ACTIVITY                                HAZARD                     H/M/L                    PRECAUTIONS                         PLACE         DATE         REVIEWER
 Dancing                                   Banging head on fence.                    L        Keeping my distance while                          Yes
                                                                                              dancing.
                                           Tripping.                                 M        Only head dance.                                   Yes
 Holding mug                               Hot drink – Hot mug.                      H        Let the drink cool.                                Yes
 Shaking rattle                            Hitting their self on the head.           M        Make sure the rattle keeps a                       Yes
                                                                                              distance.
 Posing with the wedges                    Falling                                   H        Make sure she keeps balance and                    Yes
                                                                                              the floor it flat and safe.
 Moving map around                         Paper cut                                 H        Use a laminated map.                               Yes




 Please leave this section blank:
 Risk Assessment checked by: Name …………………………………………………..                                          Signed ………………………………………………….                                   Date ……………………

         KEY:      Activity :     Describe the component part of your pursuit.
                   Hazard :       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.
                   Risk:          Assess the risk as either H (High), M (Medium) or L (Low). When concluding your assessment consider all of the circumstances.
                   Precautions:   Consider what you could do to minimise / negate the risk.
                   In Place:      Will the precautionary measures be in place at the time of the activity?
                   Review Date:   When would it be reasonable to review your assessment? Remember it might be whilst you are undertaking the activity.
                   Reviewer:      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.
V9/PALL/sspi/reviewedOct2010

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Risk assessment form

  • 1. V9 RISK ASSESSMENT RISK IN REVIEW ACTIVITY HAZARD H/M/L PRECAUTIONS PLACE DATE REVIEWER Dancing Banging head on fence. L Keeping my distance while Yes dancing. Tripping. M Only head dance. Yes Holding mug Hot drink – Hot mug. H Let the drink cool. Yes Shaking rattle Hitting their self on the head. M Make sure the rattle keeps a Yes distance. Posing with the wedges Falling H Make sure she keeps balance and Yes the floor it flat and safe. Moving map around Paper cut H Use a laminated map. Yes Please leave this section blank: Risk Assessment checked by: Name ………………………………………………….. Signed …………………………………………………. Date …………………… KEY: Activity : Describe the component part of your pursuit. Hazard : 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. Risk: Assess the risk as either H (High), M (Medium) or L (Low). When concluding your assessment consider all of the circumstances. Precautions: Consider what you could do to minimise / negate the risk. In Place: Will the precautionary measures be in place at the time of the activity? Review Date: When would it be reasonable to review your assessment? Remember it might be whilst you are undertaking the activity. Reviewer: 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. V9/PALL/sspi/reviewedOct2010