Risk Assessment Project Date Assessor Name * Designation * ElectricianTechnician Describe the work to be completed * List Potential Risks (Electrical Shock, Fall From Height, Etc) Persons at Risk (check all that apply) Myself Other workers at site Homeowners and/or their Children Visitors The Public Likelihood (L):1 = Rare2 = Unlikely3 = Possible4 = Likely5 = Very Likely Severity (S):1 = Negligible2 = Minor Injury3 = Moderate Injury4 = Major Injury5 = Fatality Likelihood Score * 1 = Rare2 = Unlikely3 = Possible4 = Likely5 = Very Likely Severity Score * 1 = Negligible (Very Minor)2 = Minor Injury3 = Moderate Injury4 = Major Injury5 = Fatality Risk Score (Add Likelihood + Severity) * Score Risk Level Action Required 1–5 Low Acceptable; monitor and review 6–10 Medium Improve controls where reasonably practicable 11–15 High Take action urgently to reduce risk 16–25 Critical Stop work until risk is reduced Steps taken to mitigate or lower risk score to 5 or less Electrical Safety Checklist Electrical power has been turned off at breaker Area is safe / people have been informed Breaker has been tagged / locked I have taken the necessary steps to mitigate risk to a score of 5 or less. Submit If you are human, leave this field blank.