Information
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Document No.
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Client / Site
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Location
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Conducted on
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Entered by:
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Area:
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HAZOB Observer: (Optional)
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When was the HAZOB issue observed?
HAZOB Type
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Select HAZOB Type:
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IMPROVEMENT SUGGESTION
Describe your suggestion / idea that would improve:
a work method or technique.
a form or document.
communication and feedback.
a piece of equipment or plant.
a tool or suggest a more suitable tool. -
HAZARD OBSERVATION
Describe the hazard you have discovered.
Identify (if possible) the type of Hazard.
Were you able to remove the hazard?
Were you able to put in place some temporary control
to protect other people until the hazard is removed?
A temporary control may mean getting someone to
stand near the hazard to warn other people.
Can you identify a cause for the hazard? -
DESIGN SLEEPER
Can you identify a potential hazard that could cause injury
or damage due to design inefficiency? Can you suggest a
better design?
EXACT LOCATION OF HAZARD / SLEEPER / IMPROVEMENTS
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Hazard Type:
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Hazard Type (tap here to select from list)
- Workplace Layout / Housekeeping
- Fire
- Plant & Equipment
- Environment
- Fall Protection
- Health & Hygiene
- Unsecured Objects
- Traffic
- Work Practices
- Chemical
- Other (Describe)
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Hazard Details - List details or take a picture(s) of the hazards you identified - Description of Hazard / Sleeper / Improvements:
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Agreed Actions (Supervisor to complete)
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Hazard Control Details - List Action Items or take a picture of how the hazard(s) will be controlled
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By Who:
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By When:
