Risk Assessment Form
| Ships Name | Ships No |
| Work Activity |
| Assessors: |
| No | Hazards associated with Activity | Possible Consequences | Existing Control / Safeguards | Severity | Likelihood | Risk Level | Additional Controls Rq’d. Y/N |
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Additional Control Measures
| Hazard No | Further action if necessary (Additional Controls)for risk level 3 or more | Responsible | Remedial action due | Date Completed |
Additional Comments:
Signed____________________________Chief Officer/Chief Engineer _____________________________ Master _______________Date
PAGE 2 OF 2
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