Risk Assessment Template Example
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4RISK ASSESSMENT TEMPLATE EXAMPLE
Section 19 of the Safety, Health and Welfare at Work Act, 2005 requires all employers to carry out a risk assessment of their risks. Use
this template to record all hazardous chemical agents that your employees are at risk from. Do not forget those chemicals which might
be generated by the work you do e.g. welding fumes
Company name:
Risk Assessor name:
Date:
Click here to enter a date.
HAZARD
WHO IS
RISK (Severity
CONTROLS IN
FURTHER ACTION
PRIORITY
ACTION DATE
ACTION
INVOLVED
and Likelihood)
PLACE
BY
Example
Splashing –
Pouring Sodium
3 process
PPE only Face
Consider eliminating
1
Immediate
Mgt.
Hydroxide
employee
skin/eye burns
shield gloves
pouring.
Solution from
(very likely &
Restructure process
bulk tank
extreme harm)
Very High Risk
*This template is for illustrative purposes only. Competent persons undertaking chemical risk assessments may amend this template to
suit site specific work activities.
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Parent category: Business