Date *

MM

DD

YYYY

Initial Risk Rating *

Low

Moderate

High

Critical

Catastrophic

By When *

MM

DD

YYYY

Residual Risk Rating *

NOTE: The residual risk rating should be 'low' at this stage, if this is not the case, think of a more effective way to control the hazard.

Low

Moderate

High

Critical

Catastrophic

Completion Date *

MM

DD

YYYY

Completed By *

First Name

Last Name