Information
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Client / Site
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Location
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Conducted on
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Task
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Reported By:
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Supervisor
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When was the HAZOB Issue observed?
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Document No.
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?
LOCATION OF HAZARD/NEAR HIT, DESIGN CHANGE, IMPROVEMNT
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Add media
DESCRIPTION OF HAZARD/NEAR HIT, DESIGN CHANGE, IMPROVEMENT
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List details or take a picture(s) of the hazard(s) you identified:
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Add media
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Select Hazard Category from List:
- Workplace Layout / Housekeeping
- Fire
- Plant & Equipment
- Environment
- Fall Protection
- Health & Hygiene
- Unsecured Objects
- Traffic
- Work Practices
- Chemical
- Other (Describe)
AGREED ACTIONS (supervisor to complete)
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List details or take a picture(s) of how the hazard(s) will be controlled
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Add media
ACTION ITEMS - How the hazard(s) will be controlled
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ACTION ITEM 1
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BY WHO?
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BY WHEN?
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ACTION ITEM 2
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BY WHO?
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BY WHEN?
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ACTION ITEM 3
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BY WHO?
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BY WHEN?
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ACTION ITEM 4
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BY WHO?
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BY WHEN?
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ACTION ITEM 5
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BY WHO?
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BY WHEN?
