风险评估表 范本

风险评估表 Risk Assessment Form日期Date:参考编号Ref. No:审查日期Review Date:评估者Assessor/s评估者签名Assessors Signature:需评估的任务Description of task to be assessed区域或部门Area or Dept:(比如：员工、承包商、公众等)Persons Exposed (e.g. employee, contractor, public etc)A 部分-首次风险鉴定和风险评估 Section A- Hazard Identification and Initial and Risk Assessment核查任务及进行情况。考虑任务中的每一步。如可能，观察任务的进行情况。核查时，确保与相关人员商议或查阅相关评估文 件，比如：书面文件和政策，任务使用的设备、化学品、物品和服务(电、汽油、压缩气体)及维护程序。Review how the task is, or is going to be, undertaken. Consider each step in the task. If possible, observe how the task is undertaken. When conducting this review, ensure you consult personnel who are involved and consider any existing documentation that may have a bearing on your assessment (e.g. documented procedures and policies, equipment used for task, chemicals, substances employed, services used (electricity, gas, compressed air etc.) or maintenance procedures.风险Hazard潜在危险Potential Harm现有的风控方法Existing Risk Control Measures风险等级Level of Risk概率Probability严重程度 Severity风险评分Risk Score1.2.3.4.5.6.7.8.9.10.B部 基于 附加 风控 Sect From tl cont revie leve分-附加风控措施A部分，确认风险等级是否超过五级(5)。如果没有超过五级(5),则完成风险评估。如果超过五级(5),则需考虑 风控措施，并核查风险情况，判断风控措施是否可以有效将风险降低至可接受的程度。重新评估风险等级，拟建附加 措施。ion B - Additional Risk Control Measuresi Section A, identify any hazard, which has a risk rating greater than five (5). If no hazards are rated greater than five hen the risk assessment is complete. If there are hazards with a risk rating of greater than five (5) then additional risk rol measures need to be considered. For each hazard identified as requiring an additional risk control measure, the hazard and decide what additional controls can be introduced to sufficiently reduce the risk to an acceptable.Re-calculate the revised risk rating taking into account the proposed additional controls.风险Hazard附加风控措施Additional ControlMeasures重估风险等级 Revised Level of Risk负责人姓名 Name ofPerson Responsible目标完成日期Target Completion Date概率Probability严重程度 Severity残余风险Residual RiskC 部分-备注 Sectio n C- Additional Comments添加与风险评估相关的备注。Add any other comments that are relevant to the risk assessment风险值 Value of Risk Tables风险概率等级 Risk Probability Ratings概率 Probability1极不可能Very unlikely2不太可能Unlikely3可能Likely4极有可能Very Likely5确定 Certain风险严重程度等级Risk Severity Ratings严重程度Severity1无损伤No injury2轻度损伤Minor injury3可报告的损伤Reportable injury4重大损伤Major injury5单人死亡/多人死亡Single/multiple death风险严重程度/概率表 Risk Severity/Probability MatrixProbability11行动方案 Actions and Timescales风险等级Risk Level行动方案 Actions and Timescales微小 Trivial无需行动方案No action required可忍受Tolerable无需附加控制措施。考虑采取性价比较高的预案或不增加额外费用的改善方法。需进行监管，确保 控制风险。需采取必要的行动预案。No additional controls are required. Consideration may be given to a more cost effective solution or improvement that imposes no additional cost burden. Monitoring is required to ensure that the controls are maintained. Limited action required.适中Moderate需努力降低风险，并判断预防成本。需进行监管，确保控制风险。需采取合理的行动方案。Efforts should be made to reduce the risk, but the cost of prevention should be carefully measured. Monitoring is required to ensure that the controls are sustained. Reasonable action required.较大Substantial需配备大量资源，降低风险。需采取紧急行动预案。Considerable resources may have to be allocated to reduce the risk. Urgent action should be taken.无法承受Intolerable风险无法承受。需立即采取行动。若哪怕再多资源也无法降低风险，则立即停止行动。Immediate Action to be taken. Level or risk unacceptable. If it is not possible to reduce the risk even with unlimited resources, Activity must cease.