Integrated Hazard Report Form

  • Select appropriate section that the hazard has been identified

  • Date and Time Hazard identified

  • Who Identified the Hazard?

  • Department Hazard is located?

  • Item of Plant/equipment (if applicable)

  • Where is the Hazard

  • What is the Hazard?

  • Photograph hazard/area

Information

  • Risk Rating guide

    risk rating guide short.png
  • Either "YES" or "NO" MUST be ticked for EVERY choice in the Hazard identification section. Where a hazard exists, sufficent control measures must be implemented and a Risk Assessment or Safe Work Procedure must be referenced.

    IF WORK CONDITIONS CHANGE, TASKS MUST BE RE-ASSESSED

Hazards - Risk Assessment

  • Electrical

  • Risks Identified

  • Take a photo of the risk

  • Telephone or other cables

  • Risks Identified

  • Take a photo of the risk

  • Pipelines - Gas, Sewer, Storm Water

  • Risks Identified

  • Take a photo of the risk

  • Vehicles, Pedestrians, General Public

  • Risks Identified

  • Take a photo of the risk

  • Weather Conditions

  • Risks Identified

  • Take a photo of the risk

  • Moving Machinery / vehicles

  • Risks Identified

  • Take a photo of the risk

  • Open Trenches, Pits, Holes

  • Risks Identified

  • Take a photo of the risk

  • Uneven, Slippery or poor surfaces

  • Risks Identified

  • Take a photo of the risk

  • Crane Position

  • Risks Identified

  • Take a photo of the risk

  • Confined Space

  • Risks Identified

  • Take a photo of the risk

  • Restricted Vision

  • Risks Identified

  • Take a photo of the risk

  • Restricted Access

  • Risks Identified

  • Take a photo of the risk

  • Fire or Explosion

  • Risks Identified

  • Take a photo of the risk

  • Working at heights

  • Risks Identified

  • Take a photo of the risk

  • Working over water

  • Risks Identified

  • Take a photo of the risk

  • Communication method

  • Risks Identified

  • Take a photo of the risk

  • Manual Handling

  • Risks Identified

  • Take a photo of the risk

  • Noise

  • Risks Identified

  • Take a photo of the risk

  • Hazardous substances

  • Risks Identified

  • Take a photo of the risk

  • Fatigue

  • Risks Identified

  • Take a photo of the risk

  • Traveling long distances

  • Risks Identified

  • Take a photo of the risk

  • Other (Not listed above)

  • Risks Identified

  • Take a photo of the risk

  • Using the Risk Assessment Matrix above, how would you rate this risk?

  • What immediate action was taken?

  • Suggested elements to control hazard

  • Your Suggestion?

  • Signature of Supervisor/Manager

  • Who was the incident reported to? (Select all that apply)

  • A copy of this report is to be forwarded to ABC-IncidentNotification@australianbeerco.com.au

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