Risk Management Risk Awareness Form

RISK MANAGEMENT RISK AWARENESS FORM

Parties and Recitals

This Risk Management Risk Awareness Form (the "Form") is entered into by and between:

WHEREAS, the Organization maintains a risk management program designed to identify, evaluate and mitigate risks associated with business operations; and

WHEREAS, the Representative/Employee performs duties or receives services that expose the Representative/Employee to operational, environmental, safety, financial, reputational and information risks; and

WHEREAS, the parties acknowledge that awareness of identified risks and adherence to prescribed mitigation procedures is necessary to reduce losses, injuries and regulatory exposure.

Scope of Work / Activities

The Representative/Employee will undertake the following work, duties or activities. The Representative/Employee acknowledges that the listed activities may involve risks described elsewhere in this Form.

Risk Identification and Acknowledgment

The Representative/Employee acknowledges awareness of the following categories of risk that may arise in connection with the Scope of Work. The Representative/Employee must review, confirm and initial applicable items.

Environmental / physical hazards (slips, falls, hazardous materials)
Operational / procedural hazards (machine operation, confined spaces)
Financial risks (loss or misstatement of assets, budgetary impacts)
Reputational risk (public exposure, negative publicity)
Information technology / cybersecurity risks (data loss, unauthorized access)
Other:

Mitigation Measures and Controls

The Organization confirms that the following mitigation measures, training and controls have been provided or scheduled. The Representative/Employee shall comply with each measure while performing the Scope of Work.

Personal Protective Equipment provided
Specific training completed or scheduled
Written procedures, permits or checklists issued
On-site supervision or safety officer assigned
Insurance coverages communicated to Representative/Employee

Reporting and Response Procedures

The Representative/Employee must immediately report any incident, near miss, defect, unsafe condition or security event to the Organization in accordance with the procedures below.

Payment Terms (if applicable)

If the Scope of Work involves a fee for risk assessment services, training or other deliverables, the parties agree to the following payment terms.

Term and Termination

This Form is effective as of the Start Date and remains in effect until the End Date or until earlier terminated as provided below.

Start Date:    End Date:

Either party may terminate this Form for material breach if the breaching party fails to cure within the notice period defined above or immediately for serious safety or regulatory violations.

Confidentiality

The Representative/Employee will hold confidential and will not disclose any nonpublic, proprietary or confidential information obtained in the course of performing the Scope of Work. Confidential information does not include information that is or becomes publicly available other than by breach of this obligation or is required to be disclosed by law, in which case the Representative/Employee shall provide prompt notice to the Organization to permit the Organization to seek protective measures.

Governing Law and Dispute Resolution

This Form shall be governed by and construed in accordance with the laws of the jurisdiction specified below. The parties agree that any dispute arising out of or relating to this Form shall be resolved by good faith negotiation; if unresolved, disputes shall be submitted to binding arbitration or adjudicated in the courts of the governing jurisdiction, at the election of the Organization, subject to mandatory statutory rights and emergency equitable relief where appropriate.

Entire Agreement and Amendments

This Form, together with any attachments or schedules expressly incorporated, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations and understandings. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

Acknowledgment and Certification

By signing below, the Representative/Employee certifies that they have read and understand the risks identified in this Form, have had the opportunity to ask questions, have received the mitigation measures and training indicated above, and agree to comply with all applicable policies, procedures and reporting requirements. The Organization certifies that the mitigation measures and information provided are, to the best of its knowledge, accurate and sufficient for the Scope of Work.

Sign Now