RISK ASSESSMENT RECORDING FORM

Location or
Address: 30 the ge!e" M# $itchen %a
Date Assess&ent
'nderta$en: ()*+(*+3
Assess&ent ,nderta$en
-#: Natasha
Acti.it# or
Sit,ation Ca/t,ring /hoto0s
Re.ie%
Date: n*a
Signat,re
1+2 3a4ard Ris$ 1(2 5ho &ight !e har&ed and ho%6 132 5hat contros e7ist to red,ce
ris$
182 5hat action can !e ta$en
to 9,rther red,ce ris$6
Tripping over the bin
Tripping over the dogs bed
Dart board falling, or any items from
the dart board falling
1-4
1-4
1-5
Anyone walking or moving near by
the bin
Anyone walking or moving near by
the bed
Anyone stood underneath the dart
board
Risk rating 4 !ove the bin to the
other side of the kit"hen
Risk rating 4 !ove the bed to
somewhere else in the kit"hen
Risk rating # $nsure the board is
se"ure and remove the items to a
safer area
Remove the bin all together
Remove the bed all together
Remove the dart board all
together
RISK RATING
a SE:ERIT; ! LIKELI3OOD c FINAL SCORE RATING: %hat needs to !e done
< D#ing or !eing /er&anent# disa!ed < 5i a&ost certain# ha//en +=>(< Sto/? Do not start acti.it# again ,nti ris$ is
controed
8 Serio,s in@,r#*ong ter& iness 8 3igh# i$e# to ha//en +0>+< 3igh ris$ e.e" 3igh /riorit#A Ta$e action
straight a%a# to contro the ris$
3 Te&/orar# disa!iit#*3 da#s o99 sic$ 3 Not so i$e# =>B Medi,& ris$ e.eA Tighten ,/ contros and
&a$e a /an to do so&ething a!o,t ris$
( 5i need &edica attention ( E.en ess i$e# 3>< Fair# o% ris$ e.eA Lo% /riorit# !,t $ee/
/ossi!e action in &ind
+ Minor in@,r# egA -r,ise" gra4e + 'ni$e# to ha//en at a +>( Lo% or tri.ia ris$A No 9,rther action
reC,iredA
SO: a 7 ! D c
Action ReC,ired Res/onsi!e Eerson Date 9or Co&/etion