Risk Management

Risk Matrix/Risk Assessment Template Form

Department Date

Details of the Risk:

Location of the hazard

Description of the Risk:

Reportedto

1 What is the likelihood of the risk tooccur:

· AlmostCertain

· Likely

· Possible

· Unlikely

· Rare

2 If the risk was to occur what would be the consequences of itoccurring:

· Negligible

· Minor

· Moderate

· Major

· Severe

3 Rate your risk using the included Risk Matrix chart and your responses from questions 1 and2:

· Low

· Medium

· High

· VeryHigh

Risk Matrix Chart

4 Recommended action to betaken

5 What specific steps will you take to manage thisrisk

6 Refer to the ‘hierarchy of control’, identify the segment on which your actions and response are based upon. Explain your decision in as much detail as possible.

7 Explain why you believe your responses are appropriate to the level of risk identified from the matrix completed.

8 After you have implemented the new changes what monitoring, and evaluation processes will you implement to achieve the intended result?

Provide at least three (3) specific examples in your answer.