Information
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Integrated Hazard Report [number] [first] [last]
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Location
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Conducted on
Integrated Hazard Report Form
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Select appropriate section that the hazard has been identified
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Date and Time Hazard identified
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Who Identified the Hazard?
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Department Hazard is located?
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Item of Plant/equipment (if applicable)
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Where is the Hazard
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What is the Hazard?
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Photograph hazard/area
Information
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Risk Rating guide
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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
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Electrical
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Risks Identified
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Take a photo of the risk
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Telephone or other cables
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Risks Identified
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Take a photo of the risk
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Pipelines - Gas, Sewer, Storm Water
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Risks Identified
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Take a photo of the risk
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Vehicles, Pedestrians, General Public
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Risks Identified
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Take a photo of the risk
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Weather Conditions
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Risks Identified
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Take a photo of the risk
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Moving Machinery / vehicles
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Risks Identified
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Take a photo of the risk
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Open Trenches, Pits, Holes
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Risks Identified
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Take a photo of the risk
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Uneven, Slippery or poor surfaces
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Risks Identified
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Take a photo of the risk
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Crane Position
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Risks Identified
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Take a photo of the risk
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Confined Space
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Risks Identified
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Take a photo of the risk
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Restricted Vision
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Risks Identified
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Take a photo of the risk
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Restricted Access
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Risks Identified
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Take a photo of the risk
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Fire or Explosion
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Risks Identified
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Take a photo of the risk
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Working at heights
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Risks Identified
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Take a photo of the risk
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Working over water
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Risks Identified
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Take a photo of the risk
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Communication method
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Risks Identified
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Take a photo of the risk
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Manual Handling
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Risks Identified
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Take a photo of the risk
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Noise
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Risks Identified
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Take a photo of the risk
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Hazardous substances
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Risks Identified
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Take a photo of the risk
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Fatigue
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Risks Identified
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Take a photo of the risk
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Traveling long distances
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Risks Identified
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Take a photo of the risk
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Other (Not listed above)
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Risks Identified
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Take a photo of the risk
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Using the Risk Assessment Matrix above, how would you rate this risk?
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What immediate action was taken?
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Suggested elements to control hazard
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Your Suggestion?
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Signature of Supervisor/Manager
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Who was the incident reported to? (Select all that apply)
- Site Manager
- Direct Manager
- Dept. Manager
- Supervisor
- Incident Email Group
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A copy of this report is to be forwarded to ABC-IncidentNotification@australianbeerco.com.au
