Enterprise risk management is an area of growing interest for state departments of transportation in the United States. This research developed a risk register spreadsheet tool—applicable at the enterprise and program levels—that supports the user in identifying risk events, defining risk categories, and assessing the likelihood (probability) and consequence (effect) of an event occurring. A state-of-the-practice survey was conducted with regard to the use of risk register tools to support enterprise- and program-level risk management at U.S. state departments of transportation, international transportation agencies, and nontransportation organizations. On the basis of the survey results and to further inform development of the risk register tool, several organizations were selected for in-depth interviews to gather additional information on their risk management practices and use of risk register tools. The resultant risk register reflects information from the interviews and examples provided by the participants. The spreadsheet-based risk register is an editable template that does not use any macros or custom code. In addition to the editable template, two prepopulated examples—one for enterprise-level risk management and one for program-level risk management—were created. While the risk register tool can help facilitate good practice risk management, the findings of this research indicate that an organization's risk management governance along with staff commitment, availability, and capability to support risk management activities are equally, if not more, important to effective risk management as the risk register tool itself.