Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Report of hazard
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Airport
- Honolulu International Airport (HIA)
- Hilo International Airport (ITO)
- Kona International Airport (KOA)
- Kalaeloa Airport (JRF)
- Dillingham Airfield (HDH)
- Kahului Airport (OGG)
- Kapalua Airport (JHM)
- Hana Airport (HNM)
- Molokai Airport (MKK)
- Kalaupapa Airport (LUP)
- Lanai Airport (LNY)
- Lihue Airport (LIH)
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Name of Person Reporting Hazardous Conition
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Date & Time of Hazardous Condition Reported
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Location of Hazardous Condition
Description of hazard
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Type of hazard
- Manual Tasks
- Gravity
- Electricity
- Machinery & Equipment
- Hazardous Chemicals
- Extreme Temperature
- Noise
- Radiation
- Biological
- Psychosocial
- Security Breech
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Explain the hazard & the context in how the hazard poses a risk
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Add photo of hazard
Assess the risk
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What would a reasonably foreseeable outcome if an incident occurred.
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Consequence
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Likelihood
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Risk Rating
Control the hazard
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Describe what you have done to make the hazard safe!
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Photo of completed actions
Long term recommendations
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Do you recommend any long term solutions or do you have any additional comments
Fire Chief
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What follow up action is required in your opinion
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Do you recommend that a formal risk assessment be conducted
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Fire Chief's Comments
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Name of Fire Chief
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Assessment Completed
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Date Reviewed By AIR - L thru AIR - LF
