RISK ASSESSMENT RECORDING FORM

Location or Address: House, Domini ue!s "edroom Acti-it+ or Situation Ca.turin/ .,oto!s
1)2 Ha3ard Ris$

Date Assessment #nderta$en: %&'(%')& Re-ie0 Date: n'a

1%2 4,o mi/,t "e ,armed and ,o05

Assessment underta$en *+: Natas,a Si/nature

162 4,at contro7s e8ist to reduce ris$

1&2 4,at action can "e ta$en to 9urt,er reduce ris$5

Be hit by the door being opened Trip over cabinet

1-5 1-4

Anyone behind the door Anyone near the cabinet moving around Anyone sat in front of the window

Risk rating -4 !arn everyone in the house not to open the door Risk rating 4-5 "ove around carefully# and watch your step$ %on&t rush 1-4 'it on the other end of the bed so you&re not sat in front of the window

(eep the door open (eep at least 1m away from the cabinet "ove the bed forwards away from the window

Bang yourself on the window

RISK RATING a SE:ERIT; < & 6 % ) D+in/ or "ein/ .ermanent7+ disa"7ed Serious in@ur+'7on/ term i77ness Tem.orar+ disa"i7it+'6 da+s o99 sic$ 4i77 need medica7 attention Minor in@ur+ e/A *ruise, /ra3e

1-4

" LIKELIHOOD < & 6 % ) 4i77 a7most certain7+ ,a..en Hi/,7+ 7i$e7+ to ,a..en Not so 7i$e7+ E-en 7ess 7i$e7+ #n7i$e7+ to ,a..en at a77

c FINAL SCORE RATING: 0,at needs to "e done )=>%< Sto.? Do not start acti-it+ a/ain unti7 ris$ is contro77ed )(>)< Hi/, ris$ 7e-e7, Hi/, .riorit+A Ta$e action strai/,t a0a+ to contro7 t,e ris$ =>B Medium ris$ 7e-e7A Ti/,ten u. contro7s and ma$e a .7an to do somet,in/ a"out ris$ 6>< Fair7+ 7o0 ris$ 7e-e7A Lo0 .riorit+ "ut $ee. .ossi"7e action in mind )>% Lo0 or tri-ia7 ris$A No 9urt,er action re uiredA

SO: a 8 " C c
Action Re uired Res.onsi"7e Derson Date 9or Com.7etion