| # | Hazard | Persons at Risk | L | S | Rating | Control Measures | L¹ | S¹ | Residual | Action / By Whom | Target Date |
|---|
| Role | Full Name | Position / Qualifications | Date |
|---|---|---|---|
| Assessor (Prepared by) | |||
| Responsible Person (Client) | |||
| Assessor Signature | Signature redacted for online preview Authorised via electronic delivery — AB SiteSafe | ||
| Client Signature | Sign to confirm receipt and implementation of this assessment | ||