Risk Assessment

Safety Plan

I. Project information:
Name of Project	Date of submission
Team Member	Phone Number	e-mail
Faculty mentor	Phone Number	e-mail
II. Project description:
II. Describe steps from project initiation to completion:
III. Given that many accidents result from an unexpected reaction or event, go back through the steps of the project and imagine what could go wrong to make what seems to be a safe and well-regulated process turn into one that could result in an accident. (See examples)
IV. Perform online research to identify any accidents that have occurred using your materials, equipment or process. State how you could avoid having this hazardous situation arise in your project.

V. For each identified hazard or “what if” situation noted above, describe one or more measures that will be taken to mitigate the hazard. (See examples of engineering controls, administrative controls, special work practices and PPE).
VI. Rewrite the project steps to include all safety measures taken for each step or combination of steps. Be specific (don’t just state “be careful”).
VII. Thinking about the accidents that have occurred or that you have identified as a risk, describe emergency response procedures to use.
VIII. List emergency response contact information:
Call 911 for injuries, fires or other emergency situations Call your department representative to report a facility concern
Name	Phone Number	Faculty or other COE emergency contact	Phone Number
IX. Safety review signatures
Faculty Review update (required for project changes and as specified by faculty mentor) Updated safety reviews should occur for the following reasons: Faculty requires second review by this date: Faculty requires discussion and possibly a new safety review BEFORE proceeding with step(s) An accident or unexpected event has occurred (these must be reported to the faculty, who will decide if a new safety review should be performed. Changes have been made to the project.
Team Member	Date	Faculty mentor	Date

Report all accidents and near misses to faculty mentor.