RISK ASSESSMENT RECORDING FORM

Location or
Address: semi-detached house
Activity or
Situation: Photoshoot
(1)

Hazard

Risk

Date Assessment
Undertaken: 2/02/15
Review
Date: 2/02/15

(2) Who might be harmed and how?

Assessment undertaken
By: Nicholas May
Signature: NM

(3) What controls exist to reduce risk

(4) What action can be taken to further reduce

risk?

cables

A1B2 You or the model may be harmed by

falling over them.

Tape over the wires to keep them in

place next to the lamp

Keep them away from where the model stands

seats/sofas

A2B2 The model or you may be harmed if

you trip over a chair or fall on to a
sofa

Keep all seats tucked away from the

people/ be aware of chair legs
sticking out

Be aware of surroundings

tables/draws

A2B2 The model may stub their toe on a

table or draw

Keep all draws & tables at a moderate

distance from the model

Dont run near tables.

low ceilings

A2B1 The model may hurt their head if

they accidently walk into a room that
has a low ceiling

The model would have to duck while

going under the low ceiling

Be aware of the environment around you and duck

if in a room with a low ceiling.

1. List hazards something with the potential to cause harm here:

Seek to quantify the level of risk the likelihood of harm arising based on the number of persons affected, how often they are exposed to the hazard and the
severity of any consequence.
2. List groups of people who are especially at risk from the significant hazards which you have identified
3. List existing controls here or note where the information may be found

4. List the risks which are not adequately controlled and the action you will take. Have regard for the level of risk, the cost of any action and the benefit you expect to
gain.

(1)

Hazard

Risk

(2) Who might be harmed and how?

(3) What controls exist to reduce

risk

(5) What action can be taken

to further reduce risk?

RISK RATING
a SEVERITY

b LIKELIHOOD

c FINAL SCORE RATING: what needs to be done

Dying or being permanently disabled

Will almost certainly happen

Serious injury/long term illness

Highly likely to happen

Temporary disability/3 days off sick

Not so likely

Will need medical attention

Even less likely

Minor injury eg. Bruise, graze

Unlikely to happen at all

16-25 Stop! Do not start activity again until risk is

controlled
10-15 High risk level, High priority. Take action
straight away to control the risk
6-9
Medium risk level. Tighten up controls and
make a plan to do something about risk
3-5
Fairly low risk level. Low priority but keep
possible action in mind
1-2
Low or trivial risk. No further action
required.

SO: a x b = c
Action Required

Responsible Person

Date for Completion