What's in the template
Two worksheet pages, an instruction and review record, and one guidance sheet.
- A Job and assessment: activity, work area, who assessed it, next review
- B Who may be harmed, the outcome for pregnant or breastfeeding workers, the PPE needed and the permits that apply
- C Hazards and measures for up to 16 job steps: hazard and harm, existing measures, risk score, additional measures in STOP order, who, by when and the effectiveness check
- D Approval by the employer or responsible person
- E Closeout, signed only when every measure is done and checked
Page 1 also carries a simple 3 x 3 risk matrix and the STOP order of measures; a site that has its own matrix uses that one. Page 3 records who was instructed and every review. The guidance sheet explains the steps, when a lighter document is enough, who does what and, for each requirement, the German and the Swiss rule side by side; where a country has no rule of its own, the sheet says so.
When do you need it?
Every employer assesses the hazards of the work and sets the measures before the work starts, then checks that the measures work and keeps the assessment up to date. This worksheet records that assessment for one job, step by step. It feeds the site's overall risk assessment and does not replace it. Where the same job is done under the same conditions, one assessment covers it.
Rules it follows
Germany
- Occupational Safety and Health Act (ArbSchG) §§3 to 6, 8, 12 and 13
- DGUV Vorschrift 1 §§3, 4, 6 and 13, with DGUV Regel 100-001 (June 2025)
- TRBS 1111, risk assessment for work equipment
- Maternity Protection Act (MuSchG) §10 and Youth Employment Protection Act (JArbSchG) §§28a and 29
- Occupational Safety Act (ASiG) §§3 and 6 and Works Constitution Act (BetrVG) §§81 and 87
Switzerland
- VUV (Ordinance on the Prevention of Accidents and Occupational Diseases), Art. 3 to 11a
- Ordinances to the Employment Act: ArGV 1 Art. 62 and 63 (maternity), ArGV 3 Art. 3, 5 and 6, ArGV 5 Art. 4 (young workers)
- EKAS guideline 6508 (ASA guideline)
- Suva 66089 (hazard identification for small businesses) and Suva 66099 (Suva method)
Rules checked against the current editions on 15 October 2026.