Occupational 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 fil l 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 1a. No.
1b. Work Activity
1c. Hazard
Next Review Date:
2. Risk Evaluation 1d.
2a.
Possible Accident / Ill Health & Persons-at-Risk
Existing Risk Control (if any)
2b. Severity
2c. Likelihood
3. Risk Control 2d. Risk Level
3a. 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)
