Appendix 1 Staffordshire County Council General Risk Assessment Record Form Section/Service/Team……………………………………………… 2. Assessor(s)…………………………………………………… 3. Description of Task/Activity/Area/Premises etc. …………………………………………………………………………………………. What are Who might What are you already doing? What is the What further action, if any, is Action What is the the be harmed List the control measures risk rating necessary, if so what action Completed risk rating hazards? and how? already in place H, M, L? is to be taken by whom and the date now H, M, – – See section by when? completed and L? 5 sign. See Section 5 1. 2. 3. 4. 5. 4. Tick (√) if any of the identified hazards relate to any of the following specific themes: Hazardous Manual Display Fire Work Equip / Stress Individual Person such as Young Person Substance Handling Screen Equip Machinery New/ Expectant Mother or Service User
Appendix 1 Staffordshire County Council General Risk Assessment Record Form Section/Service/Team……………………………………………… 2. Assessor(s)…………………………………………………… 3. Description of Task/Activity/Area/Premises etc. …………………………………………………………………………………………. What are the hazards? Who might be harmed and how? What are you already doing? List the control measures already in place What is the risk rating – H, M, L? See section 5 What further action, if any, is necessary, if so what action is to be taken by whom and by when? Action Completed the date completed and sign. What is the risk rating now – H, M, L? See Section 5 1. 2. 3. 4. 5. 4. Tick (√) if any of the identified hazards relate to any of the following specific themes: Hazardous Substance Manual Handling Display Screen Equip Fire Work Equip / Machinery Stress Individual Person such as Young Person New/ Expectant Mother or Service User
hsf_19_general_risk_assessment.docx