SCIENCE EXPERIMENT RISK ASSESSMENT FORM

EXPERIMENT NAME	AUTHORED BY	EXPERIMENT DATE

PARTICIPANT NAME(S)
SUPERVISOR NAME(S)

EXPERIMENT DESCRIPTION

TOOLS AND EQUIPMENT USED

ITEM NAME	QUANTITY	STANDARD MEASUREMENT	ITEM PURPOSE	POTENTIAL HAZARDS	STANDARD HANDLING PROCEDURES

PROBABILITY KEY	IMPACT KEY	RISK LEVEL MATRIX	Negligible	Minor	Moderate	Significant	Severe
Highly Unlikely	Negligible	Highly Likely	Low / Med	Medium	Med / Hi	High	High
Unlikely	Minor	Likely	Low	Low / Med	Medium	Med / Hi	High
Possible	Moderate	Possible	Low	Low / Med	Medium	Med / Hi	Med / Hi
Likely	High	Unlikely	Low	Low / Med	Low / Med	Medium	Med / Hi
Highly Likely	Severe	Highly Unlikely	Low	Low	Low / Med	Medium	Medium

EXPERIMENT RISK ASSESSMENT

ACTIVITY	RISK	HAZARD	PROBABILITY	IMPACT	RISK LEVEL	CONTROL MEASURES

ADDITIONAL INFORMATION

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