QA/QC  › Generic Master Forms  › Risk Assessment Form
Form · QC-GEN-FRM-011
Risk Assessment Form
29 checkpoints across 7 sections. Before commencing any high-risk activity (height work, excavation, hot work, demolition, heavy lifting, electrical work, confined space, etc.). Assessment valid for activity duration; reassess if conditions change.
29 Checkpoints
7 Sections
Per activity; updated if scope or conditions change; typically one assessment per major activity
HSE Officer / Safety Officer, Site Supervisor

Checklist Preview

S.No.CheckpointIS RequirementStatus
A. Activity Details
A1Activity Description - Clear description of the work to be performed. Example: Concreting of foundation raft for Building A using ready-mix concrete pump. Placement to commence from south end and proceed northward over 3 days
Acceptance: Description comprehensive and unambiguous; scope clearly defined
Mandatory
OK
NC
NA
HOLD
A2Location Details - Exact location on site with reference to drawings. Grid reference, level, building/block name. Example: Foundation Raft Level -2, Grid A-F/1-6, Building A East Wing
Acceptance: Location traceable on drawings; unique identification; accessible for planning
Mandatory
OK
NC
NA
HOLD
A3Scheduled Date(s) - Start and end date of activity. If spanning multiple days, note the schedule (e.g., Daily 6 AM - 6 PM, Extended to 10 PM for curing work). Include weather considerations
Acceptance: Dates realistic and aligned with project schedule; weather contingencies noted
Mandatory
OK
NC
NA
HOLD
A4Estimated Duration - Total number of days/hours for completion. Account for contingencies. Example: 3 days for concreting, 1 day for curing setup, 28 days for curing period (non-active supervision)
Acceptance: Duration realistic based on quantity and methodology; buffers included for contingencies
Mandatory
OK
NC
NA
HOLD
A5Number of Workers - Expected number of workers involved. Example: Concrete placement - 15 workers (6 pump operators, 4 vibrator operators, 5 finishing team)
Acceptance: Realistic headcount; breakdown by role helps identify hazard exposure
Mandatory
OK
NC
NA
HOLD
A6Equipment to be Used - List all major equipment, machinery, and tools. Example: Concrete pump (25 m reach), vibrators (5 units), scaffolding (temporary platforms), formwork (steel frames), safety net, hoists
Acceptance: Comprehensive list; equipment specifications noted; mobile equipment tracked
Mandatory
OK
NC
NA
HOLD
B. Hazard Identification Table
B1S.No - Numbered list of identified hazards (1, 2, 3, ...)
Acceptance: Sequential numbering; at least 5-10 hazards identified for complex activities
Mandatory
OK
NC
NA
HOLD
B2Hazard Description - Clearly describe each hazard. Examples: (1) Fall from height while working on scaffolding, (2) Electrocution from exposed electrical cables, (3) Concrete burn from uncured concrete contact, (4) Heat stress during prolonged sun exposure, (5) Noise exposure from vibrators and pump engine
Acceptance: Hazards specific and identifiable; not generic statements; site-contextual
Mandatory
OK
NC
NA
HOLD
B3Who is at Risk - Identify the person(s) or group exposed to hazard. Example: (1) Fall hazard affects - all workers at height, especially inexperienced workers on scaffolding, (2) Electrical hazard affects - all workers near power distribution, pump operators
Acceptance: Risk groups identified; vulnerable populations (new workers, supervisors, public) noted
Mandatory
OK
NC
NA
HOLD
B4Existing Controls - What controls are already in place for this hazard? Example: (1) Fall - Scaffolding present, guardrails installed, safety net below, (2) Electrical - Temporary DB with RCCB protection, grounded cables, (3) Heat stress - Adequate water supply, shaded rest areas
Acceptance: Existing controls listed factually; effectiveness not assumed; gaps identified
Mandatory
OK
NC
NA
HOLD
C. Risk Rating & Matrix
C1Likelihood Rating (1-5) - Probability of hazard resulting in an incident. Scale: 1=Unlikely (< 1% chance), 2=Low (1-10%), 3=Possible (10-50%), 4=Likely (50-90%), 5=Almost Certain (> 90%). Base on past incidents, industry data, worker experience
Acceptance: Rating justified based on evidence; consistent with hazard exposure frequency
Mandatory
OK
NC
NA
HOLD
C2Severity Rating (1-5) - Potential harm if hazard occurs. Scale: 1=Insignificant (minor cuts/bruises), 2=Minor (minor injury, first aid), 3=Serious (medical treatment, lost time), 4=Critical (hospitalization, permanent disability), 5=Catastrophic (fatality, multiple deaths)
Acceptance: Rating based on injury/damage potential; considers worst-case scenario
Mandatory
OK
NC
NA
HOLD
C3Risk Score Calculation - Calculate Risk = Likelihood × Severity. Example: Fall hazard: Likelihood=4 (likely given height and novice workers), Severity=5 (potential fatality) = Risk Score 20
Acceptance: Calculation correct; scores guide control measure prioritization
Mandatory
OK
NC
NA
HOLD
C4Risk Level Classification - Apply color coding: 1-4 Green (Low - Accept risk), 5-9 Yellow (Medium - Mitigate), 10-15 Orange (High - Urgent mitigation), 16-25 Red (Extreme - Work cannot proceed without control)
Acceptance: Color/level assigned per matrix; drives approval decision
Mandatory
OK
NC
NA
HOLD
Showing 14 of 29 checkpoints ·
A. Activity Details
A1Activity Description - Clear description of the work to be performed. Example: Concreting of foundation raft for Building A using ready-mix concrete pump. Placement to commence from south end and proceed northward over 3 days
Mandatory (Generic)
Description comprehensive and unambiguous; scope clearly defined
OKNCNAHOLD
A2Location Details - Exact location on site with reference to drawings. Grid reference, level, building/block name. Example: Foundation Raft Level -2, Grid A-F/1-6, Building A East Wing
Mandatory (Generic)
Location traceable on drawings; unique identification; accessible for planning
OKNCNAHOLD
A3Scheduled Date(s) - Start and end date of activity. If spanning multiple days, note the schedule (e.g., Daily 6 AM - 6 PM, Extended to 10 PM for curing work). Include weather considerations
Mandatory (Generic)
Dates realistic and aligned with project schedule; weather contingencies noted
OKNCNAHOLD
A4Estimated Duration - Total number of days/hours for completion. Account for contingencies. Example: 3 days for concreting, 1 day for curing setup, 28 days for curing period (non-active supervision)
Mandatory (Generic)
Duration realistic based on quantity and methodology; buffers included for contingencies
OKNCNAHOLD
A5Number of Workers - Expected number of workers involved. Example: Concrete placement - 15 workers (6 pump operators, 4 vibrator operators, 5 finishing team)
Mandatory (Generic)
Realistic headcount; breakdown by role helps identify hazard exposure
OKNCNAHOLD
A6Equipment to be Used - List all major equipment, machinery, and tools. Example: Concrete pump (25 m reach), vibrators (5 units), scaffolding (temporary platforms), formwork (steel frames), safety net, hoists
Mandatory (Generic)
Comprehensive list; equipment specifications noted; mobile equipment tracked
OKNCNAHOLD
B. Hazard Identification Table
B1S.No - Numbered list of identified hazards (1, 2, 3, ...)
Mandatory (Generic)
Sequential numbering; at least 5-10 hazards identified for complex activities
OKNCNAHOLD
B2Hazard Description - Clearly describe each hazard. Examples: (1) Fall from height while working on scaffolding, (2) Electrocution from exposed electrical cables, (3) Concrete burn from uncured concrete contact, (4) Heat stress during prolonged sun exposure, (5) Noise exposure from vibrators and pump engine
Mandatory (Generic)
Hazards specific and identifiable; not generic statements; site-contextual
OKNCNAHOLD
B3Who is at Risk - Identify the person(s) or group exposed to hazard. Example: (1) Fall hazard affects - all workers at height, especially inexperienced workers on scaffolding, (2) Electrical hazard affects - all workers near power distribution, pump operators
Mandatory (Generic)
Risk groups identified; vulnerable populations (new workers, supervisors, public) noted
OKNCNAHOLD
B4Existing Controls - What controls are already in place for this hazard? Example: (1) Fall - Scaffolding present, guardrails installed, safety net below, (2) Electrical - Temporary DB with RCCB protection, grounded cables, (3) Heat stress - Adequate water supply, shaded rest areas
Mandatory (Generic)
Existing controls listed factually; effectiveness not assumed; gaps identified
OKNCNAHOLD
C. Risk Rating & Matrix
C1Likelihood Rating (1-5) - Probability of hazard resulting in an incident. Scale: 1=Unlikely (< 1% chance), 2=Low (1-10%), 3=Possible (10-50%), 4=Likely (50-90%), 5=Almost Certain (> 90%). Base on past incidents, industry data, worker experience
Mandatory (Generic)
Rating justified based on evidence; consistent with hazard exposure frequency
OKNCNAHOLD
C2Severity Rating (1-5) - Potential harm if hazard occurs. Scale: 1=Insignificant (minor cuts/bruises), 2=Minor (minor injury, first aid), 3=Serious (medical treatment, lost time), 4=Critical (hospitalization, permanent disability), 5=Catastrophic (fatality, multiple deaths)
Mandatory (Generic)
Rating based on injury/damage potential; considers worst-case scenario
OKNCNAHOLD
C3Risk Score Calculation - Calculate Risk = Likelihood × Severity. Example: Fall hazard: Likelihood=4 (likely given height and novice workers), Severity=5 (potential fatality) = Risk Score 20
Mandatory (Generic)
Calculation correct; scores guide control measure prioritization
OKNCNAHOLD
C4Risk Level Classification - Apply color coding: 1-4 Green (Low - Accept risk), 5-9 Yellow (Medium - Mitigate), 10-15 Orange (High - Urgent mitigation), 16-25 Red (Extreme - Work cannot proceed without control)
Mandatory (Generic)
Color/level assigned per matrix; drives approval decision
OKNCNAHOLD
Showing 14 of 29 ·
Inspection Sign-Off
Risk Assessment Approved - Work May Proceed
Risk Assessment Approved With Conditions - Specify conditions
Risk Assessment Rejected - Work Cannot Proceed Until Reviewed
Name / Sign / Date
Name / Sign / Date
Name / Sign / Date