RISK ASSESSMENT RECORDING FORM

Location or
Address: 337 Warrington Road
Activity or
Situation: Photo-shoot
(1)

Hazard

Derelict Building

Date Assessment
Undertaken: 1st February 2015
Review
Date:
Risk

(2) Who might be harmed and how?

Assessment undertaken
By: Aaron Tonge
Signature

(3) What controls exist to reduce

risk

(4) What action can be taken

to further reduce risk?

A5B2 Model and myself. The building

could collapse or part of the
buildings structure could fall and
hurt me or my model.

The building is structurally secure

and water tight so the building
should not be dangerous.

My model and I should wear

protective equipment such as a
hard hat.

A1B4 Myself, model and camera. We

could slip and fall over on the wet
surface. If I fall the camera which I
am holding onto may break with the
impact.

Walking steadily across the

surface.

Wear better clothing such as boots

which are suitable for the
particular surface.

A2B2 A branch could possibly hit my

model, myself and even possibly the
camera.

Avoid being near trees with

loose branches.

Make sure we are well an

away from trees with hanging
branches.

Grass

Branches

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