CMCO EHS — Risk Assessment Form

Assessor Name* Person completing this assessment

Employee / Operator Name Worker observed performing the task

Date Date of observation

Site* Which facility this assessment is for

Building Physical building where task occurs

Department* Department or work cell

Specific Area / Station Workstation, line, or zone within the department

Job / Task Description* Specific enough that someone else could locate this task

Equipment Involved Tools, machines, vehicles, or materials

Task Frequency How often per shift or day

Task Duration Total time per shift

Routine Task? Regularly scheduled part of job

Down Days? Days when this task is NOT performed

SOP / WI Exists? Is there a written procedure for this task?

SOP / WI Number Document number if known

PPE Requirements Standard PPE is required by default; add any task-specific items Standard PPE (safety glasses, safety shoes, gloves)

Safe Work Considerations Lighting, housekeeping, ventilation, space constraints, temperature, noise, etc.

Special Requirements & Permits

Flag any programs or permits that apply. These require separate documentation beyond this blitz form.

Toggle Yes for any hazard present — comments and control fields expand automatically. Leave No for hazards that do not apply.

Check the OSHA 300 log before completing the Probability score below. Record up to three incidents — prioritize the most severe. This directly drives the Probability factor.

#	Date	OSHA Classification, Body Part & Description
Inc. 1
Inc. 2
Inc. 3

Formula: (Exp₁ + Dur₁ + Exp₂ + Dur₂) × Probability × Severity × Control
Select the employee band first. The inactive band defaults to 1/1 (N/A) and still contributes minimally to the sum — this is by design.

Step 1 — How many employees perform this task?*

Step 2 — Exposure & Duration — Click a row to select. Only the active band is shown.

Exposure — 1–3 Employee Band (Exp₁)
1	Periodically — rarely comes up, infrequent and unpredictable
2	Occasionally — regular but not constant, perhaps weekly
3	Frequently — daily or multiple times per shift

Duration — 1–3 Employee Band (Dur₁)
1	Less than 5 minutes
2	5 to 10 minutes
3	More than 10 minutes, not continuous
4	Continuous throughout the shift

Exposure — 4+ Employee Band (Exp₂)
2	Periodically — rarely comes up, infrequent and unpredictable
3	Occasionally — regular but not constant
4	Frequently — daily or multiple times per shift

Duration — 4+ Employee Band (Dur₂)
2	Less than 5 minutes
3	5 to 10 minutes
4	More than 10 minutes, not continuous
5	Continuous throughout the shift

↑ Select the employee band above to unlock Probability, Severity & Control scoring

Probability* — Review Past Incidents
1	No incidents in last 3 years — task appears well-managed
2	One incident in last 3 years
3	One incident in last 2 years — more recent history raises risk
4	More than one incident in last 2 years — hazard is actively causing harm

Severity* — Worst Credible Outcome
1	First aid only — treatable on-site, no medical referral
2	Medical attention or lost time — clinic/ER or restricted duty
3	Long-term illness or serious injury — lasting consequences, surgery
4	Death or permanent disability — if the energy source is capable of it

Control* — Hierarchy of Controls (0 = best)
0	Elimination — hazard removed entirely (RPI = 0)
1	Substitution — safer alternative in place
2	Engineering controls — guards, ventilation, interlocks
3	Administrative controls — SOPs, signage, rotation
4	PPE — does not eliminate the hazard
5	Behavior only — no formal control. Action required.

Priority follow-up items, suggested controls, immediate hazards observed, who to notify e.g. Guard on press #4 has visible gap — recommend engineering review. Operator noted discomfort after 2 hr — flag for ergo deep-dive.

Assessor Signature

Supervisor / EHS Review

Date Reviewed

Filling this out for the first time? Leave the ID blank — it stays Revision 1. Re-assessing a task because conditions changed? Look up the original record's ID in the dashboard, enter it below, and the revision advances automatically. The original assessment is preserved as history.

Re-assessing an existing task? Enter the original record's ID from the dashboard. Leave blank for a brand-new assessment.

Revision Number New assessments are Revision 1

Risk Assessment Form

Assessment submitted