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Risk Assessment Form
Life Safety Risk Assessment
Life Safety Risk Assessment
Date of Assessment
Inspection Interval
Annual
Quarterly
Monthly
Weekly
Asset
Location
Observation
Issue
Potential Hazard
Potential Consequences
Mitigating Factors
Existing Controls
Severity Rating
1-Negligible
2-Negligible
3-Low
6-Medium
9-High
Likelihood Rating
1-Negligible
2-Negligible
3-Low
6-Medium
9-High
Risk Rating with Current Factors and Controls
High
Medium
Low
Negligible
Notes
Assessor Name
Job Title
Date of Assessment
Date to be Reviewed
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