contoh form risk assessment

RISK ASSESSMENT

JOB DESCRIPTION:		CHECK PPE REQUIRED
LOCATION:		Hard Hats		Cotton Gloves		Dust Mask
RISK ASSESSMENT NO.		Safety Shoes		Leather Gloves		Face Shield
DATE:		Safety Glasses		Safety Harness		Life Rings
		Hearing Protection		Work Vest

JOB STEPS/TASKS	HAZARD DESCRIPTION	INITIAL			REQUIRED CONTROLS	RESIDUAL RISK
Separate the job into the main tasks and record them in sequence	Describe all hazards identified for each task based on observations and experience Note:  Additional hazards may be caused by interaction with other work	Severity	Probability	RISK	Describe fully all equipment, facility, and/or procedure controls applicable for each hazard (i.e. if PPE is used as a control, it must be specifically described.) All controls must be valid in that they reduce severity, probability or both.	Classify risk rating from matrix for each hazard with controls in place.

Risk Assessment done by : 

Name :                                                 ,Rank :                                               , Sign: