Free OSHA Risk Assessment Format Template
OSHA Risk Assessment Format
Company Name: ______________________
Location/Department: ______________________
Date of Assessment: ______________________
Conducted By: ______________________
Reviewed By: ______________________
1. Scope of Assessment:
-
Purpose: Briefly describe the reason for the assessment (e.g., routine safety review, new equipment, workplace change).
-
Areas Covered: Specify areas or processes covered in the assessment.
2. Identify Hazards:
|
Hazard Description |
Location |
Potential Harm |
Risk Level (Low, Medium, High) |
Who Is Affected |
|---|---|---|---|---|
|
Example: Wet floors |
Office Entrance |
Slip and fall |
High |
All employees |
|
Example: Exposure to chemical vapors |
Lab Area |
Respiratory issues |
Medium |
Lab workers |
3. Risk Evaluation:
For each hazard identified, assess the likelihood of an incident and the severity if it occurs.
-
Likelihood: Rare, Unlikely, Likely, Almost Certain
-
Severity: Minor, Moderate, Major, Catastrophic
-
Risk Rating (Likelihood x Severity):
(Low, Medium, High, Critical)
Example:
|
Hazard |
Likelihood |
Severity |
Risk Rating |
|---|---|---|---|
|
Wet floors |
Likely |
Moderate |
High |
|
Exposure to chemical vapors |
Unlikely |
Major |
Medium |
4. Existing Controls:
List current safety controls in place for each hazard.
Example:
-
Wet floors: "Signage for wet floors, slip-resistant mats."
-
Chemical exposure: "Ventilation system, PPE for lab workers."
5. Additional Control Measures Required:
Identify any further safety measures or corrective actions needed to reduce risks.
Example:
-
Wet floors: "Improve lighting and increase cleaning schedule."
-
Chemical exposure: "Conduct regular air quality checks, provide better PPE."
6. Action Plan:
-
Action Steps: Detailed steps to be taken to mitigate the risks.
-
Responsible Person: Name or role of the person responsible for implementing the actions.
-
Completion Date: Deadline for implementing each measure.
-
Status: (Not Started, In Progress, Completed)
Example:
|
Action Steps |
Responsible Person |
Completion Date |
Status |
|---|---|---|---|
|
Increase signage and improve floor maintenance |
Safety Officer |
01/15/2025 |
In Progress |
|
Regular air quality checks for chemical exposure |
Lab Supervisor |
02/01/2025 |
Not Started |
7. Review and Monitoring:
-
Review Date: Specify when the assessment and controls will be reviewed for effectiveness.
-
Monitoring Plan: Describe how ongoing monitoring will be conducted.
8. Sign-Off:
-
Safety Officer/Manager Name & Signature: ______________________
-
Date: ______________________
-
Employee Representative (if applicable): ______________________
-
Date: ______________________
