After the Seveso disaster occurred more than 40 years ago, there has been an increasing awareness of the potential impacts that similar accident events can occur in a wide range of process establishments, where the handling and production of hazardous substances pose a real threat to society and the environment. In these industrial sites denominated "Seveso sites," the urgent need for an effective strategy emerged markedly to handle hazardous activities and to ensure safe conditions. Since then, the main challenging research issues have focused on how to prevent such accident events and how to mitigate their consequences leading to the development of many risk assessment methodologies. In recent years, researchers and practitioners have tried to provide useful overviews of the existing risk assessment methodologies proposing several reviews. However, these reviews are not exhaustive because they are either dated or focus only on one specific topic (e.g., liquefied natural gas, domino effect, etc.). This work aims to overcome the limitations of the current reviews by providing an up-to-date and comprehensive overview of the risk assessment methodologies for handling hazardous substances within the European industry. In particular, we have focused on the current techniques for hazards and accident scenarios identification, as well as probability and consequence analyses for both onshore and offshore installations. Thus, we have identified the research streams that have characterized the activities of researchers and practitioners over the years, and we have then presented and discussed the different risk assessment methodologies available concerning the research stream that they belong to.