System · 49 documentsPart of Environmental Management System

Environmental Risk Assessment Form

Form · FORM-31346

Version 2

The Environmental Risk Assessment Form helps you assess the environmental impact of an item or service you plan to buy, before you commit to it.

It includes a guidance sheet, a likelihood and consequence scale, a risk matrix with the action each score needs, and a hierarchy of control. An assessment worksheet records the item, its potential risks, the risk level, the mitigation strategies and who is responsible.

Written by SafetyDocs safety experts, who have been writing safety documents since 2004.

Environmental Risk Assessment Form

FormVersion 2

Guidance Sheet for Environmental Risk Assessment Form

Risk Matrix

Likelihood	Criteria	Description

Likelihood ↑	InsignificantNo effect, or so minor that the effect is acceptable	MinorMinor first aid treatment, minimal business disruption, minimal environmental effect	ModerateSerious injuries, medium business interruption, medium environmental impact	MajorExtensive injuries or fatality, significant business interruption, environmental harm, prosecution	CatastrophicMultiple permanent disabilities or fatalities, business failure, substantial environmental harm, prosecution or imprisonment
	Consequence →
Almost certainExpected in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
LikelyWill probably occur in most circumstances	2 Moderate	2 Moderate	3 High	4 Acute	4 Acute
PossibleCould possibly occur at some time	1 Low	2 Moderate	2 Moderate	3 High	4 Acute
UnlikelyUnlikely but possible	1 Low	1 Low	2 Moderate	3 High	4 Acute
RareHighly unlikely to occur	1 Low	1 Low	2 Moderate	2 Moderate	3 High

1 LowRecord and monitor. Proceed with work, and review the risks regularly.
2 ModerateMaintain control measures. Be cautious when working, and monitor and review regularly.
3 HighReview before commencing work. Introduce new controls or maintain high-level controls to lower the risk level, and monitor the controls frequently.
4 AcuteDo not proceed until the risk level is reduced. Immediately introduce high-level controls, and re-assess before proceeding.

Score	Action

Hierarchy of Control

Environmental Risk Assessment

Assessor Name / Signature: —
Job Title: —

Date: —

Item/Service	Potential Risks	Risk Level	Mitigation Strategies	Responsible Person

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What it covers

13 fields

Likelihood
Criteria
Description
Score
Action
Assessor Name / Signature
Job Title
Date
Item/Service
Potential Risks
Risk Level
Mitigation Strategies

and 1 more

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Environmental Risk Assessment Form

Preview of the Environmental Risk Assessment Form

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What it covers

13 fields

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