KD-BL-RA-001
Risk Assessment — Blank with 5×5 Matrix
A blank but guided risk assessment for a task the range has nothing pre-written for: the task, who could be harmed, a hazards table scored 1 to 5 for likelihood and severity before and after controls, controls following the general principles of prevention, the matrix and bands, the decision, the review, sign-off and the briefing record.
3 pages · 197 fillable fields · works in Adobe Reader, Preview, Chrome, or on a phone — or complete it online in your browser and download the finished document.
Page 1 of 3 — click to enlarge
Read all 3 pages first — watermarked sample, no email Before you submit: the checklist
Statutory basis, cited on the form
- MHSWR 1999 regs 3 and 4 and Schedule 1
What it is not
It is not a completed document and it is not health and safety advice. You must adapt it to your site and have a competent person complete and sign it off. See why we don't say "compliant".
Format
AcroForm fillable PDF. Every field has a tooltip. Tab order follows the reading order. Works on desktop and mobile, in Adobe and non-Adobe readers.
This revision was prepared against legislation current at 10 August 2026. Revision A0. Check kubitdocs.com/revisions for the current revision before use.
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