Explanatory notes on completion of a General Health & Safety Risk Assessment Form Division: Source of Risk: HG/CHO/NAS/Function: Primary Risk Category: Hospital Site/Service: Secondary Risk Category (s): Dept/Service Site: Name of Risk Owner (BLOCKS): Date of Assessment: Signature of Risk Owner: Unique ID No: PERSON DUE DATE HAZARD & RISK DESCRIPTION IMPACTS/VUNERABILITIES EXISTING CONTROL MEASURES ADDITIONAL CONTROLS REQUIRED FOR ACTION Refer to Impact Table as per HSE Risk Detail the control measures to Detail the measures necessary to Enter the date Using the Impact Context and Enter the name Assessment Tool and enter the include all measures put in place to eliminate or further reduce the level of by which Cause (ICC) approach, describe the of the impacts and vulnerabilities that the eliminate or reduce the risks and risk. implementation hazard and associated risks. responsible risk has on the employees, service include engineering controls, of additional person for For further information on this users, and the organisation. policies, procedures, protocols, controls to Consider the hierarchy of controls: implementation approach please refer to to guidelines (clinical and non-clinical), Elimination/ substitution/ engineering/ mitigate the risk of each control access relevant documentation. training, emergency arrangements, are due. administrative/ PPE. measure. preventative maintenance controls etc. Consider the interim and long term When examining existing control measures. measures, consider the adequacy, method of implementation and level of effectiveness in eliminating or minimising risk to the lowest practicable level. RISK STATUS INITIAL RISK RATING Impact Risk Rating Open Closed Likelihood Monitor
Explanatory notes on completion of a General Health & Safety Risk Assessment Form Division: Source of Risk: HG/CHO/NAS/Function: Primary Risk Category: Hospital Site/Service: Secondary Risk Category (s): Dept/Service Site: Name of Risk Owner (BLOCKS): Date of Assessment: Signature of Risk Owner: Unique ID No: HAZARD & RISK DESCRIPTION IMPACTS/VUNERABILITIES EXISTING CONTROL MEASURES ADDITIONAL CONTROLS REQUIRED PERSON FOR ACTION DUE DATE Using the Impact Context and Cause (ICC) approach, describe the hazard and associated risks. For further information on this approach please refer to to access relevant documentation. Refer to Impact Table as per HSE Risk Assessment Tool and enter the impacts and vulnerabilities that the risk has on the employees, service users, and the organisation. Detail the control measures to include all measures put in place to eliminate or reduce the risks and include engineering controls, policies, procedures, protocols, guidelines (clinical and non-clinical), training, emergency arrangements, preventative maintenance controls Detail the measures necessary to eliminate or further reduce the level of risk. Consider the hierarchy of controls: Elimination/ substitution/ engineering/ administrative/ PPE. Enter the name of the responsible person for implementation of each control measure. Enter the date by which implementation of additional controls to mitigate the risk are due. etc. Consider the interim and long term When examining existing control measures. measures, consider the adequacy, method of implementation and level of effectiveness in eliminating or minimising risk to the lowest practicable level. INITIAL RISK RATING RISK STATUS Likelihood Impact Risk Rating Open Monitor Closed
healthy-ireland-hse-staff-physical-activity-programme-checklist.docx