Activity Based Risk Assessment Form 4l262c
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Occupational Safety and Health Division 18 Havelock Road #03-02 Singapore 059764 Tel: 64385122 www.mom.gov.sg [email protected]
Activity-based Risk Assessment Form This form may take you 30 minutes to complete. You will need the following information to fill in the form: •
Process Flow Chart
RISK ASSESSMENT FORM ACTIVITY-BASED RISK ASSESSMENT INVENTORY OF WORK ACTIVITIES Company: No.
Process/Location
Work Activities
Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment
RISK ASSESSMENT FORM ACTIVITY-BASED RISK ASSESSMENT FORM Company: Process/ Location: Approved by: (Name, designation) (Date)
Conducted by: (Names, designations) (Date) Last Review Date:
1. Hazard Identification
Next Review Date:
2. Risk Evaluation
1a.
1b.
1c.
1d.
No.
Work Activity
Hazard
Possible Accident / Ill Health & Persons-at-Risk
2a. Existing Risk Control (if any)
3. Risk Control
2b.
2c.
2d.
3a.
Severity
Likelihood
Risk Level
Additional Risk Control
Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment
3b. Action Officer, Designation (Follow-up date)
Activity-based Risk Assessment Form This form may take you 30 minutes to complete. You will need the following information to fill in the form: •
Process Flow Chart
RISK ASSESSMENT FORM ACTIVITY-BASED RISK ASSESSMENT INVENTORY OF WORK ACTIVITIES Company: No.
Process/Location
Work Activities
Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment
RISK ASSESSMENT FORM ACTIVITY-BASED RISK ASSESSMENT FORM Company: Process/ Location: Approved by: (Name, designation) (Date)
Conducted by: (Names, designations) (Date) Last Review Date:
1. Hazard Identification
Next Review Date:
2. Risk Evaluation
1a.
1b.
1c.
1d.
No.
Work Activity
Hazard
Possible Accident / Ill Health & Persons-at-Risk
2a. Existing Risk Control (if any)
3. Risk Control
2b.
2c.
2d.
3a.
Severity
Likelihood
Risk Level
Additional Risk Control
Instructions on how to use Activity-Based Risk Assessment Form can be found in Guidelines on Risk Assessment
3b. Action Officer, Designation (Follow-up date)
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