Employer's report on identified hazards, assessment results and risk reduction measures. Completed using the survey findings and the approved method.
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No. dated
Scope: . Survey period: — . Basis and assessors: .
The assessment was conducted as part of occupational risk management under Articles 214 and 218 of the Labor Code of the Russian Federation (ТК РФ). Method: risk matrix. Scales, criteria, method details and limitations: . Survey materials: The survey includes a walk-through of the premises and workplaces, observation of routine and non-routine operations, discussions with employees, and analysis of instructions, equipment documentation, special assessment of working conditions (СОУТ) results, incidents and previous measures. For inaccessible sites, record the limitations rather than an absence of hazards.
| Site / place | Position / operation | Observation conditions | Document / date | Limitation |
Additional details based on actual conditions: .
A hazard is described as a source and a possible event with consequences for the employee. Work, setup, cleaning, repairs, movement and contractor access are taken into account. Each hazard is assigned a stable ID linking it to the assessment card and action plan.
| ID | Place / operation | Hazard source | Hazardous event | Persons exposed | Consequences |
Additional details based on actual conditions:
Each hazard is assessed, taking account of measures actually in place. Scores are substantiated by observations; an absence of accidents does not in itself demonstrate a low likelihood.
| Risk ID | Scale scores | Calculation / rule | Level | Rationale | Assessment card |
Additional details based on actual conditions:
Priority of measures: eliminate the hazard; replace the hazardous process with a less hazardous one; introduce engineering controls and collective protection; organize safe working practices; provide personal protective equipment (СИЗ). An immediate threat requires an immediate response before the scheduled deadline.
| Risk ID | Measure / expected result | Person responsible | Deadline | Resource | Verification of completion |
Additional details based on actual conditions:
Surveyed places are included in the register; places not inspected and limitations are identified separately. Unacceptable risks are referred to the head of the organization for work restrictions and resource allocation. Measures and monitoring are established for other risks. A calculated threshold not being exceeded does not remove mandatory safety requirements. Additional details based on actual conditions: Review procedure: A review is initiated when technology, equipment, materials or workplaces change, a new hazard is identified, an incident occurs, measures prove ineffective or mandatory requirements change. The person responsible records the trigger, arranges a survey and communicates the revised measures to employees. Additional details based on actual conditions: . Attachments: . Risk assessment does not replace the special assessment of working conditions. Decisions on whether work may proceed take account of mandatory requirements, not only the numerical index. Prepared by and signatures: Approved by:
______________ / /
The method version and scales are applied consistently in all assessment cards.
| Indicator | Grade / score | Observable criterion | Supporting source |
| Range / combination | Risk level | Whether work may proceed | Urgency of measures Monitoring procedure |
| Department | Workplace | Positions / headcount | Types of work | Card number | Survey date |
This is a draft template. Before use, have a lawyer review the text and adapt it to the specific circumstances. This document is not legal advice.
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5 of 20 fields are taken from the company, employee or counterparty record, the questionnaire can be dictated to the AI, and the finished document comes with a number, a PDF and an acknowledgement record.