| Risk Report Source | ||
| Name of Risk: | ||
| Location of Risk: | ||
| Description of Risk: | ||
| x | ||
| x | ||
| x | ||
| x | ||
| x | ||
| x | ||
| Recommendation: | ||
| x | ||
| x | ||
| x | ||
| x | ||
| x | ||
| x | ||
| Reported by | Signature | Date |
| x | ||
| Risk Rating Assessment (Refer to table page 10.6) | |||
| Risk (Likelihood) | Injury (Consequences) | Initial Risk Rating | Residual Risk Rating |
| x | |||
| Manager, Supervisor or Health and Safety Coordinator Action Plan | ||||
| Brief Detail of Action Required: | Date | Signature | ||
| x | ||||
| x | ||||
| x | ||||
| x | ||||
| x | ||||
| x | ||||
| x | ||||
| Health Monitoring Required (Y/N): (If the answer is yes, add to page 10.5 Health Monitoring) | ||||
| Risk Register Updated (Y/N): | Section: | Number: | ||
| Approved by (Senior Manager) | Signature | Date | ||