The Risk Assessment Acknowledgement Form is a crucial document in the Dutch workplace safety framework, required under the Working Conditions Act (Arbowet) and associated regulations. This document should be used whenever significant workplace risks are identified through a formal risk assessment process, or when employees are exposed to new or modified workplace hazards. It serves multiple purposes: documenting that employees have been informed of risks, confirming their understanding of safety measures, and establishing a clear record of risk communication. The form is particularly important in high-risk industries but is relevant across all sectors where workplace hazards exist. It helps organizations demonstrate compliance with Dutch and EU safety regulations while protecting both employer and employee interests through clear documentation of risk awareness and accepted safety protocols.
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1. Parties: Identification of the employer/organization conducting the risk assessment and the employee/individual acknowledging the risks
2. Background: Context of the risk assessment, including the purpose and scope of the assessment
3. Definitions: Key terms used in the document, including technical terms and risk-related terminology
4. Risk Assessment Details: Overview of when and where the risk assessment was conducted, and by whom
5. Identified Risks: Comprehensive list of identified risks in the workplace or situation
6. Control Measures: Description of existing control measures and safety protocols in place
7. Employee Responsibilities: Outline of the employee's responsibilities in following safety procedures and reporting incidents
8. Emergency Procedures: Summary of emergency protocols and procedures related to identified risks
9. Declaration: Formal acknowledgment statement confirming understanding of risks and agreement to follow safety procedures
10. Signatures: Space for dated signatures of all relevant parties
1. Specific Equipment Risks: Used when the risk assessment involves specific machinery or equipment
2. Chemical Hazards: Required when workplace involves handling of hazardous substances
3. Personal Protective Equipment: Included when specific PPE requirements need to be acknowledged
4. Training Requirements: Added when specific training is mandatory for risk mitigation
5. Health Surveillance: Included when ongoing health monitoring is required due to specific risks
6. Remote Work Considerations: Added when assessment includes risks related to remote or home working
7. Third Party Risks: Used when work involves risks to or from third parties or contractors
1. Schedule A - Risk Assessment Matrix: Detailed matrix showing risk likelihood and impact ratings
2. Schedule B - Site-Specific Hazards: Detailed list of hazards specific to different work locations or areas
3. Schedule C - Safety Equipment Specifications: Technical specifications of required safety equipment
4. Appendix 1 - Incident Reporting Procedures: Detailed procedures for reporting incidents or near-misses
5. Appendix 2 - Emergency Contact Information: List of relevant emergency contacts and procedures
6. Appendix 3 - Safety Training Records: Documentation of completed safety training relevant to identified risks
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