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(3A) RA Sample Form

This document is an activity-based risk assessment form used to evaluate risks for projects and processes. It contains sections to identify hazards, existing risk controls, evaluate risk level based on severity and likelihood, identify additional risk controls needed, and assign implementation responsibilities and due dates. Risk is prioritized using a risk prioritization number calculated based on the severity and likelihood of an event. The form is used and approved by project safety leaders and management to systematically identify and mitigate risks.

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myo lwin
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482 views2 pages

(3A) RA Sample Form

This document is an activity-based risk assessment form used to evaluate risks for projects and processes. It contains sections to identify hazards, existing risk controls, evaluate risk level based on severity and likelihood, identify additional risk controls needed, and assign implementation responsibilities and due dates. Risk is prioritized using a risk prioritization number calculated based on the severity and likelihood of an event. The form is used and approved by project safety leaders and management to systematically identify and mitigate risks.

Uploaded by

myo lwin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Safety Form : HSE-RA(3A)

ACTIVITY-BASED RISK ASSESSMENT FORM


Department Project Safety Conducted By;(Name, Designation, Date, Signature Approve By; Ref
Process/Activities RA Leader No.
Signature; 01/P
Project/Location RA Member 1 HL

Original RA Member 2 Name;


Assessment date
Last Review Date RA Member 3 Designation;

Next Review Date RA Member 4 Date;

Hazard Identification Risk Evaluation Risk Control


N Work Hazards & Existing Risk Seve Likeli R Additional Risk seve Likeli R Implement Due Rem
o Activities Possible Controls rity hood P Control rity hood P ation Date/ arks
. Injury/Ill-health (if any) N N Person/ Follow
Person-at-risk Action Up date
Officer
1

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Safety Form : HSE-RA(3A)

#RPN = Risk Prioritization Number

Likelihood Remote (1) Occasional (2) Frequent (3)


Severity
Major (3) Medium (3) High (6) High (9)
Moderate (2) Low (2) Medium (4) High (6)
Minor (1) Low (1) Low (2) Medium (3)

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